{ "hospital_name": "Harlingen Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Harlingen Medical Center" ], "hospital_address": [ "5501 South Expressway 77 Harlingen, TX 78550" ], "license_information": { "license_number": "562143518", "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": "Todd Man" }, "type_2_npi": [ "1881688976" ], "standard_charge_information": [ { "description": "17-HYDROXYPREGNENOLONE", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.25, "discounted_cash": 22, "minimum": 19.16, "maximum": 165, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 65.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 72.54 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.98 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 19.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.98 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.89 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.83 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 20.31 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.2 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.23 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "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": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.98 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 19.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.89 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 37.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 19.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.9 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.06 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.09 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "17-Ketosteroids, Urine", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 495, "discounted_cash": 12, "minimum": 10.75, "maximum": 396, "payers_information": [ { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.75 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.13 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.75 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.71 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.37 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 25.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.7 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.75 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "(T4),THYROXINE", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.81, "discounted_cash": 6, "minimum": 5.77, "maximum": 121.448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.85 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.12 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "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": 7.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.11 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.06 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "4C ANTIBODY ID", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1584.75, "discounted_cash": 358, "minimum": 14.4648, "maximum": 1267.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 716.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 810.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 369.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 537.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 379.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "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": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 591.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "1ST DEGREE BURN INITIAL TREATM - 16000 - 408091634", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235.15, "discounted_cash": 200, "minimum": 62.2516, "maximum": 1269.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1235.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 225.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 249.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 249.86 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.83, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 310.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA ENDO RPR ILIO-ILIAC/RUPTUR", "code_information": [ { "code": "34708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7556.7, "minimum": 380.8577, "maximum": 6045.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2539 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2495.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2766.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2766.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "*11ADDL NECK SPINE FUSION", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4502.27, "minimum": 226.9144, "maximum": 4502.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4502.27 } ] } ] }, { "description": "AAA DELYD PLCMNT EXT ADD VESSE", "code_information": [ { "code": "34711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.95, "minimum": 61.6367, "maximum": 2323.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 402.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "1ST DEGREE BURN INITIAL TREATM - 16000 - 416016000", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1269.12, "discounted_cash": 200, "minimum": 62.2516, "maximum": 1269.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1269.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 225.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 249.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 249.86 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.83, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 310.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA PLCMNT EXT PROS EACH ADD V", "code_information": [ { "code": "34709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.25, "minimum": 68.5934, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 436.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "11-OXO-ANDROGENS PANEL", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 937.5, "discounted_cash": 24, "minimum": 20.24, "maximum": 750, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 48.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 68.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 76.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.09 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 21.45 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.55 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.09 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.98 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.32 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.24 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA DELYD PLCMNT EXT INIT VESS", "code_information": [ { "code": "34710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3357.82, "minimum": 169.2341, "maximum": 2686.256, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1080.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1197.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1197.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "30 min. mod.sed. 5y/o and up", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.42, "minimum": 26.4625, "maximum": 560.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 560.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 49.1, "10th_percentile": 49.1, "90th_percentile": 49.1, "count": "1 through 10" }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 47.71, "10th_percentile": 47.71, "90th_percentile": 47.71, "count": "1 through 10" } ] } ] }, { "description": "AAA PLCMNT EXTEN PROS INITIAL", "code_information": [ { "code": "34709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.25, "minimum": 68.5934, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 436.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "3D MAPPING", "code_information": [ { "code": "93613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12780.1, "minimum": 644.117, "maximum": 10224.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3573 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 889.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 989.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 989.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA ENDO RPR AO-AORTIC/RUPTURE", "code_information": [ { "code": "34702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7516.3, "minimum": 378.8215, "maximum": 6013.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2489.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2759.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2759.23 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "5-HYDROXYINDOLEACETIC ACID,URINE", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.74, "discounted_cash": 12, "minimum": 10.84, "maximum": 66.992, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.84 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.67 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.55 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.02 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.18 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "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": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.84 } ] } ] }, { "description": "AAA PLCMNT EXTEN PROS INITIAL VES", "code_information": [ { "code": "34709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.25, "minimum": 68.5934, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 436.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "6-PGD,RBC", "code_information": [ { "code": "84085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.5, "discounted_cash": 9, "minimum": 7.93, "maximum": 48.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 30.02 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.83 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.27 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.76 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA ENDO RPR W/AO-UNI-ILIAC GR", "code_information": [ { "code": "34703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5669.05, "minimum": 285.7201, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1876.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2079.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2079.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA ACCESS & PERC CLOSURE>12FR", "code_information": [ { "code": "34713", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 541.08, "minimum": 27.2704, "maximum": 541.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 541.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 541.08 } ] } ] }, { "description": "AAA PLCMNT EXTEN PROSD INITL V", "code_information": [ { "code": "34711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904, "minimum": 61.6367, "maximum": 2323.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 402.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "A-1-ANTITRYPSIN PHENOTYPE", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.6, "discounted_cash": 14, "minimum": 12.15, "maximum": 107.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 45.98 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.66 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.86 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.14 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.66 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.4 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.4 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.15 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA OPEN FEM EXPOSURE W/CONDUI", "code_information": [ { "code": "34714", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.8, "minimum": 55.6819, "maximum": 883.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA ENDO RPR AO-BI-ILIAC/RUPTU", "code_information": [ { "code": "34706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9404.95, "minimum": 474.0095, "maximum": 7523.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3109.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3446.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3446.73 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA STENT REPR UNIBODY BIFUR P", "code_information": [ { "code": "34703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.25, "minimum": 285.7201, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1876.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2079.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2079.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA ENDO RPR W/AO-AORTIC GRAFT", "code_information": [ { "code": "34701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5028.15, "minimum": 253.4188, "maximum": 4022.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1666.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1847.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1847.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA PLCMNT EXTEN PROSD EA ADD", "code_information": [ { "code": "34711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904, "minimum": 61.6367, "maximum": 2323.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 402.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA ENDO RPR AO-UNI-ILIAC/RUPT", "code_information": [ { "code": "34704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9436.7, "minimum": 405.783, "maximum": 7549.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3126.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3466.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3466.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ABG SAMPLING W/PERCUTANEOUS", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.5, "discounted_cash": 133, "minimum": 2.4948, "maximum": 563.2, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 443.77, "10th_percentile": 443.77, "90th_percentile": 443.77, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 49.35, "10th_percentile": 49.35, "90th_percentile": 49.35, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 71.92, "10th_percentile": 71.92, "90th_percentile": 71.92, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "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": 49.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 23.02, "10th_percentile": 23.02, "90th_percentile": 23.02, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 44.43, "10th_percentile": 44.43, "90th_percentile": 44.43, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 52.39, "10th_percentile": 44.5, "90th_percentile": 52.39, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 49.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 47.94, "10th_percentile": 47.94, "90th_percentile": 47.94, "count": "1 through 10" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 49.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 49.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 49.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 49.5 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA ENDO RPR W/ILIO-ILIAC GRAF", "code_information": [ { "code": "34707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4691.1, "minimum": 236.4314, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2539 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1554.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1723.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1723.36 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA STENT W/MOD BIFUR PROS - 34704 - 401090161", "code_information": [ { "code": "34704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.25, "minimum": 405.783, "maximum": 7549.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3126.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3466.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3466.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA ENDO RPR W/AO-BI-ILIAC GRA", "code_information": [ { "code": "34705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6416.17, "minimum": 323.375, "maximum": 5132.936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2063.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2287.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2287.69 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ABI'S ANKLE BRACHIE INDICES", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.5, "discounted_cash": 133, "minimum": 12.6025, "maximum": 450.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 266, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 311.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 346.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 346.72 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 168.96, "10th_percentile": 168.96, "90th_percentile": 168.96, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 157.17, "10th_percentile": 157.17, "90th_percentile": 157.17, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA OPEN AXILLA/SBC EXP W/COND", "code_information": [ { "code": "34716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1573.41, "minimum": 79.2999, "maximum": 1258.728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA STENT W/MOD BIFUR PROS - 34704 - 90161", "code_information": [ { "code": "34704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.25, "minimum": 405.783, "maximum": 7549.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3126.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3466.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3466.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA ENDO RPR W/AORTO-UNI ILIAC", "code_information": [ { "code": "34704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.52, "minimum": 405.783, "maximum": 7549.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3126.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3466.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3466.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ABO DISCREPANCY", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.45, "discounted_cash": 133, "minimum": 2.51, "maximum": 450.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.66 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "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": 84.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.99 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA PLCMNT EXTEN PROSD EA ADD VES", "code_information": [ { "code": "34711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2603.25, "minimum": 61.6367, "maximum": 2323.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 402.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ABD PARACENTESIS W/IMG GUIDE", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3807.75, "discounted_cash": 906, "minimum": 115.1464, "maximum": 4381.96, "payers_information": [ { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 577.89, "10th_percentile": 577.89, "90th_percentile": 577.89, "count": "1 through 10" }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 800.53, "10th_percentile": 800.53, "90th_percentile": 800.53, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1013.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1123.87 } ] } ] }, { "description": "AAA OPEN AXILLA/SBC EXPOSURE", "code_information": [ { "code": "34715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235.3, "minimum": 62.2591, "maximum": 988.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA PLCMNT EXTEN PROSD INITL VES", "code_information": [ { "code": "34711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2603.25, "minimum": 61.6367, "maximum": 2323.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 402.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 446.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ABD PARACENTESIS W/O IMG GUIDE", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3807.75, "discounted_cash": 906, "minimum": 115.1464, "maximum": 3046.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1013.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA PLCMNT EXT PROS EACH ADD VESS", "code_information": [ { "code": "34709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.25, "minimum": 68.5934, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 436.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AAA STENT REPR UNIBODY BIFUR PROS", "code_information": [ { "code": "34703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8051.25, "minimum": 285.7201, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1876.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2079.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2079.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ABDOMEN SURGERY PROCEDURE", "code_information": [ { "code": "49999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3436.85, "discounted_cash": 906, "minimum": 173.2172, "maximum": 2997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1013.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA PLCMNT EXTENSION PROSTH", "code_information": [ { "code": "34709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1360.98, "minimum": 68.5934, "maximum": 6441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 436.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 483.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ABD PCENTESIS/PERITONEAL LAV I", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2284.65, "discounted_cash": 906, "minimum": 115.1464, "maximum": 3046.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1013.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2284.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AAA TRANSCATH FIXATION DEVICE", "code_information": [ { "code": "34712", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2856.5, "minimum": 143.9676, "maximum": 2285.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 922.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1022.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1022.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "Acc via Bil Tree into Sm Bowel", "code_information": [ { "code": "47541", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14736.6, "discounted_cash": 6471, "minimum": 742.7246, "maximum": 12942.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8412.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 12942.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4011.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4446.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4446.36 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6665.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9707.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9060.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8412.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6859.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 8412.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10030.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 6795.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10030.75, "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": 6795.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8412.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 10677.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6471.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABD PARACENTESIS W/IMAGING", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4131.8, "discounted_cash": 906, "minimum": 115.1464, "maximum": 4381.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1013.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 800.53, "10th_percentile": 800.53, "90th_percentile": 800.53, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACETAMINOPHEN", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 394, "minimum": 1, "maximum": 315.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.55 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.01 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.72 }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.55 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.14 } ] } ] }, { "description": "ABG SAMPLING W/PERCUTANEOUS PU", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 563.2, "discounted_cash": 133, "minimum": 2.4948, "maximum": 563.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 563.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 266, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 140.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 155.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 155.91 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 443.77, "10th_percentile": 443.77, "90th_percentile": 443.77, "count": "1 through 10" }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 49.35, "10th_percentile": 49.35, "90th_percentile": 49.35, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 71.92, "10th_percentile": 71.92, "90th_percentile": 71.92, "count": "1 through 10" }, { "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 23.02, "10th_percentile": 23.02, "90th_percentile": 23.02, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 44.43, "10th_percentile": 44.43, "90th_percentile": 44.43, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 52.39, "10th_percentile": 44.5, "90th_percentile": 52.39, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 563.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 47.94, "10th_percentile": 47.94, "90th_percentile": 47.94, "count": "1 through 10" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABG", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.33, "discounted_cash": 26, "minimum": 21.9, "maximum": 287.704, "payers_information": [ { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 23.21 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.12 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.79 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 74.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 82.9 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 258.71, "10th_percentile": 258.71, "90th_percentile": 258.71, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACETYLCHOLINE REC BINDING", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.2, "discounted_cash": 36, "minimum": 30.55, "maximum": 146.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 73.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 104.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 116.29 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.85 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.1 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "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": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.36 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 60.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.17 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.07 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABO GROUPING", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 563.2, "discounted_cash": 133, "minimum": 2.51, "maximum": 450.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 266, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 311.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 346.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 346.72 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.66 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.99 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABG A-LINE", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350, "discounted_cash": 26, "minimum": 21.9, "maximum": 287.704, "payers_information": [ { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 23.21 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.12 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.79 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 74.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 82.9 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 258.71, "10th_percentile": 258.71, "90th_percentile": 258.71, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABG (VENOUS)", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.63, "discounted_cash": 26, "minimum": 21.9, "maximum": 287.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 74.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 82.9 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 258.71, "10th_percentile": 258.71, "90th_percentile": 258.71, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 23.21 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.12 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.79 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACETYLCHOLINE REC BLOC AB", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.85, "discounted_cash": 36, "minimum": 30.55, "maximum": 146.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 73.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 104.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 116.29 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.85 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.1 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "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": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.36 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 60.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.17 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.07 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8657, "minimum": 6219.65, "maximum": 15151.2025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10236.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7044.53 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11255.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 15151.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8917.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11255.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 11255.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7792.05, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9177.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 11255.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13419.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 9090.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13419.64, "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": 9090.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11255.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14285.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7314.26 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8657.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABLATION ADD'L ARRHYTHMI", "code_information": [ { "code": "93655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2389.45, "minimum": 120.4283, "maximum": 2389.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1278.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1421.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1421.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ABG W/O2 SATURATION", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450, "discounted_cash": 78, "minimum": 34.84, "maximum": 360, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 157.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 225.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 250.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 250.49 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.71 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 66.17 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.71 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.33 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 102.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 70.14 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.37 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.38 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.09, "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": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.71 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 66.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.33 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 129.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 66.17 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.45 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.35 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACTH STIM,21 HYDROXYLASE DEFIC", "code_information": [ { "code": "80402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.25, "discounted_cash": 86, "minimum": 73.05, "maximum": 629.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 173.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 248.71 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 276.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 276.53 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.99 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.29 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 92.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 113.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 77.43 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 91.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.45 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.19 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "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": 91.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.99 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.29 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 143.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.7 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.74 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.22 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7487, "minimum": 3930.47, "maximum": 23323.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8588.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8724.74 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9733.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 13102.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7711.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9733.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 9733.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6738.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7936.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 9733.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11604.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 7861.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11604.9, "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": 7861.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9733.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 12353.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3930.47 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 7487.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABO AND RH", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232, "discounted_cash": 133, "minimum": 2.51, "maximum": 450.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 232, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 232 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 232 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 337.92, "10th_percentile": 139.2, "90th_percentile": 337.92, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.66 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.99 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACTH STIM,ADRENAL INSUFF", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.1, "discounted_cash": 32, "minimum": 27.4, "maximum": 130.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 65.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 93.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 103.73 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.88 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.88 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 29.04 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.96 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "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": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.88 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.88 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.62 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 53.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 27.4 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.78 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.29 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.47 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACETONE/KETONE", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217, "discounted_cash": 4, "minimum": 3.8, "maximum": 173.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.71 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "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": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.71 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.95 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABO RH GROUPING,PATIENT", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.63, "discounted_cash": 133, "minimum": 2.51, "maximum": 450.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 97.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 97.63 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.66 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.99 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 97.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13766, "minimum": 6598.78, "maximum": 24090.6225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17425.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13033.31 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17895.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 24090.62, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13766.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 13766.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14179.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 13766.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13766.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17895.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 17895.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12389.46, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14592.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 17895.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21337.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 14454.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21337.46, "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": 14454.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 13766.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17895.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22714.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13766.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6598.78 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13766.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 13766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13766.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACETONE/KETONES,BLD,QUAN", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.98, "discounted_cash": 8, "minimum": 6.86, "maximum": 171.184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.98 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.03 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "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": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.86 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACETYLCHOLINESTERASE", "code_information": [ { "code": "82013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.5, "discounted_cash": 12, "minimum": 10.32, "maximum": 127.6, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.21 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "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": 12.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.52 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 24.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 39.08 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 } ] } ] }, { "description": "ABO-CHRG ONLY", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 563.2, "discounted_cash": 133, "minimum": 2.51, "maximum": 450.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 266, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 311.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 346.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 346.72 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 337.92, "10th_percentile": 139.2, "90th_percentile": 337.92, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.66 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.51 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.99 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACETYLCHOLINE MODUL ANTIBODIES", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.48, "discounted_cash": 18, "minimum": 15.46, "maximum": 156.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 58.51 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.38 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.91 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.27 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "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": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.38 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.78 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.33 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.73 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACID PHOSPHOTASE,TOTAL", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.75, "discounted_cash": 7, "minimum": 6.42, "maximum": 53.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.81 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.81 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.42 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.37 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.42 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.76 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACT CLOTTING TIME - 85347 - 300090048", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.68, "discounted_cash": 4, "minimum": 3.6, "maximum": 89.336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.82 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACTH STIM,3 BETA-HYDROXYD DEFIC", "code_information": [ { "code": "80406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 708.5, "discounted_cash": 78, "minimum": 65.74, "maximum": 566.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 156.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 223.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 248.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 117.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 101.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 82.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 101.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 69.68 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 82.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.49 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.46 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "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": 82.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 101.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.45 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 129.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 65.74 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.62 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.46 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.68 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACT CLOTTING TIME - 85347 - 401090404", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.68, "discounted_cash": 4, "minimum": 3.6, "maximum": 89.336, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.82 } ] } ] }, { "description": "ACTIVATED CLOTTING TIME", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.67, "discounted_cash": 4, "minimum": 3.6, "maximum": 89.336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.82 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACTINOMYCES ANTIBODY", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 10, "minimum": 8.55, "maximum": 73.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "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": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Acetadote 6,000MG/30ML INJ", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "66220020730", "type": "NDC" }, { "code": "J0132", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 55.31, "10th_percentile": 31.27, "90th_percentile": 79.36, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 123.42, "10th_percentile": 123.42, "90th_percentile": 123.42, "count": "1 through 10" } ] } ] }, { "description": "ACTIVATED PROT RESIST - CHRG ONLY", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78, "discounted_cash": 15, "minimum": 12.87, "maximum": 131.52, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.33 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "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": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.13 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.91 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.58 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 48.72 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.13 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.64 } ] } ] }, { "description": "ACETONE/KETONES", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217, "discounted_cash": 4, "minimum": 3.8, "maximum": 173.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.71 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "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": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.71 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.95 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACTIVATED PROTEIN C RESISTANCE", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.25, "discounted_cash": 15, "minimum": 12.87, "maximum": 146.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 48.72 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.13 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.33 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "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": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.13 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.91 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.58 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "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": 8349, "minimum": 5628.79, "maximum": 14611.6775, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9802.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8419.57 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10854.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 14611.68, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8600.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10854.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 10854.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7514.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8850.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 10854.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12941.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 8767.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12941.77, "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": 8767.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10854.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13776.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5628.79 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8349.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACT CLOTTING TIME - 85347 - 90404", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.15, "discounted_cash": 4, "minimum": 3.6, "maximum": 89.336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.82 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACTIN SMOOTH MUSCLE AB LC", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.25, "discounted_cash": 12, "minimum": 10.12, "maximum": 48.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.12 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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": 16514, "minimum": 11585.25, "maximum": 28900.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21293.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19717.11 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21468.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 28900.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17010.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21468.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 21468.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14863.14, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17505.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 21468.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25597.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 17340.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25597.63, "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": 17340.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21468.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27249.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17291.7 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16514.6, "additional_payer_notes": "100.00% 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": 41207, "minimum": 19815.1, "maximum": 78031.9, "payers_information": [ { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41207.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53570.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 53570.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 37087.06, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43680.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 53570.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 63872.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 43268.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 63872.09, "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": 43268.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 41207.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 53570.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 41207.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41207.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 67992.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41207.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41207.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78031.9 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 41207.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41207.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 41207.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41207.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 56046.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41207.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49383.18 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 53570.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 72113.72, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 41207.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41207.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 41207.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41207.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42444.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 41207.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9822, "minimum": 4136.98, "maximum": 18450, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11876.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11300.18 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12769.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 17189.92, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10117.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12769.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 12769.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8840.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10412.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 12769.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15225.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 10313.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15225.36, "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": 10313.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12769.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16207.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4136.98 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9822.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21014, "minimum": 16215.55, "maximum": 36776.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27627.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22870.26 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27319.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 36776.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 21015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21014.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 21014.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21645.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 21014.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21014.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27319.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 27319.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18913.46, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22275.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 27319.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32573.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 22065.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32573.25, "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": 22065.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 21014.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 27319.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 34674.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21014.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25620.5 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 21014.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 21015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21014.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15752, "minimum": 6575.9, "maximum": 27567.6275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20221.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15752.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17387.75 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20478.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 27567.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15752.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15752.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 15752.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15752.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16225.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 15752.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15752.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20478.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 20478.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14177.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16698.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 20478.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24417.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 16540.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24417, "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": 16540.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 15752.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20478.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15752.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15752.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 25992.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15752.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15752.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24229.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15752.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15752.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 15752.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15752.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7084, "minimum": 2652.88, "maximum": 12397.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8022.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6566.49 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9209.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 12397.77, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7296.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9209.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 9209.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6376, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7509.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 9209.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10980.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 7438.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10980.88, "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": 7438.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9209.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 11689.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2652.88 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 7084.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8128, "minimum": 7315.461, "maximum": 15750, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9491.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9042.26 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10566.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 14224.51, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8372.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10566.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 10566.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7315.46, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8615.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 10566.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12598.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 8534.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12598.85, "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": 8534.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10566.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13411.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9311.63 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8128.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADD'L SKINSUB GRAFT LOW 100SQ", "code_information": [ { "code": "C5274", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8746.3, "minimum": 440.8135, "maximum": 6997.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10230, "minimum": 9207.441, "maximum": 45640.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12449.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10230.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10560.19 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13299.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 17903.36, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10230.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10230.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 10230.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10230.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10537.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 10230.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10230.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13299.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 13299.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9207.44, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10844.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 13299.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15857.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 10742.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.28, "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": 10742.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 10230.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13299.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10230.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10230.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16880.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10230.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10230.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12086.2 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10230.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10230.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 10230.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10230.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADMINISTRATION INFLUEN VACCINE", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.05, "discounted_cash": 46, "minimum": 11.7457, "maximum": 186.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 68.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 75.65 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 60.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADP FLUID LC", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400, "discounted_cash": 8, "minimum": 6.8, "maximum": 320, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.76 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.8 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.72 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.21 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "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": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.8 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.22 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8051, "minimum": 6869.45, "maximum": 14089.9325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9383.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8052.66 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10466.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 14089.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8292.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10466.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 10466.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7246.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8534.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 10466.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12479.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 8453.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12479.65, "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": 8453.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10466.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13284.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8800.08 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8051.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6629, "minimum": 5751.764, "maximum": 18817.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7382.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6333.64 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8618.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 11601.84, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6828.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8618.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 8618.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5966.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7027.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 8618.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10275.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6961.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10275.91, "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": 6961.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8618.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 10938.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7893.51 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6629.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17283, "minimum": 12150, "maximum": 30246.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22376.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19866.17 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22468.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 30246.16, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17283.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 17283.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17802.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 17283.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17283.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22468.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 22468.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15555.17, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18320.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 22468.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26789.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 18147.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26789.43, "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": 18147.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 17283.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22468.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 17283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 28517.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17283.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23295.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17283.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 17283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17283.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADAMSTS13 Activity Reflex Pane", "code_information": [ { "code": "45397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 675, "minimum": 34.02, "maximum": 675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 675 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 675 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 675 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 675 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 675 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6405, "minimum": 5689.55, "maximum": 11209.5725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7066.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6524.15 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8327.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 11209.57, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6597.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8327.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 8327.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5764.92, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6789.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 8327.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9928.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6725.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9928.48, "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": 6725.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8327.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 10569.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7047.78 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6405.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AEROSOL GEN DEMO AND/OR EVAL", "code_information": [ { "code": "94664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.8, "discounted_cash": 218, "minimum": 28.9699, "maximum": 1102.464, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 689.76, "10th_percentile": 689.76, "90th_percentile": 689.76, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 339.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.2, "median_amount": 139.76, "10th_percentile": 139.76, "90th_percentile": 139.76, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 437.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 526.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 574.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 574.8 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.34, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.02, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS ANTIBODY", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.7, "discounted_cash": 12, "minimum": 10.81, "maximum": 78.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.94 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.21 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.12 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.26 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.94 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.82 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.6 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5728, "minimum": 3935.4592, "maximum": 21021.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6114.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4310.33 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7447.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 10025.17, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5900.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7447.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 7447.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5155.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6072.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 7447.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8879.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6015.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8879.44, "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": 6015.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7447.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 9452.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5340.03 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5728.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AIRWAY INHALATION TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 865.6, "discounted_cash": 218, "minimum": 43.6262, "maximum": 1102.464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 865.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 437.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 526.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 584.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 584.99 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.34, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 339.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIR AG IA DETCT IMMU TECH", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.25, "discounted_cash": 11, "minimum": 10.06, "maximum": 87.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.1 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.81 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.58 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.65 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.42 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.03 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13020, "minimum": 8731.45, "maximum": 22785.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16376.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13020.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13992.93 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16926.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 22785.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13020.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13020.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 13020.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13020.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13411.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 13020.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13020.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16926.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 16926.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11718.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13801.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 16926.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20181.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 13671.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20181.62, "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": 13671.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 13020.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16926.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13020.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13020.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21483.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13020.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13020.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13053.6 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13020.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13020.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 13020.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13020.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALANINE AMINO TRANSFERASE (ALT)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.71, "discounted_cash": 5, "minimum": 4.45, "maximum": 200.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.85 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADMIN PHARMACOLOGIC AGENT - 93463 - 401091486", "code_information": [ { "code": "93463", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4891.04, "minimum": 246.5084, "maximum": 4026.696, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 290.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 323.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ADD'L ABLATION AFIB", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2389.45, "minimum": 120.4283, "maximum": 2389.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1418.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1418.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ALBUMIN,QUAN", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.5, "discounted_cash": 7, "minimum": 6.35, "maximum": 42.8, "payers_information": [ { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.67 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.07 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "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": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN,SERUM", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.43, "discounted_cash": 4, "minimum": 4.16, "maximum": 132.344, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.74 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.41 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.95 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "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": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10014, "minimum": 5963.15, "maximum": 21137.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12145.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10014.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9138.4 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13018.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 17525.06, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10014.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10014.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 10014.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10014.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10314.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 10014.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10014.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13018.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 13018.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9012.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10615.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 13018.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15522.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 10515.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15522.17, "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": 10515.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 10014.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13018.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10014.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10014.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16523.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10014.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10014.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21137.3 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10014.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10014.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 10014.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10014.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN,URINE/OTHER QNT-CHRG ONLY", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.9, "discounted_cash": 7, "minimum": 6.35, "maximum": 42.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.07 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "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": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.67 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFB SMEAR", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.5, "discounted_cash": 5, "minimum": 4.53, "maximum": 164.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "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": 5.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.73 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.01 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5937, "minimum": 5282, "maximum": 16875.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6408.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5540.72 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7718.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 10390.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6115.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7718.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 7718.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5343.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6293.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 7718.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9203.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6234.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9203.26, "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": 6234.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7718.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 9797.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16875.3 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5937.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADMIN PHARMACOLOGIC AGENT - 93463 - 91486", "code_information": [ { "code": "93463", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5033.37, "minimum": 246.5084, "maximum": 4026.696, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 290.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 323.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AFP SERUM", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.66, "discounted_cash": 16, "minimum": 14.09, "maximum": 154.128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.33 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.94 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.32 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "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": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.46 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% 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": 14912, "minimum": 10697.95, "maximum": 26096.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19038.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16321.41 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19385.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 26096.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15359.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19385.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 19385.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13420.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15806.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 19385.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23113.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 15657.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23113.91, "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": 15657.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19385.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24605.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17655.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14912.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11534, "minimum": 6750, "maximum": 33130.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14285.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11534.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12975.1 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14995.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 20185.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11534.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11534.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 11534.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11534.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11880.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 11534.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11534.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14995.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 14995.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10381.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12226.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 14995.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17878.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 12111.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17878.94, "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": 12111.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 11534.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14995.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11534.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11534.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19032.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11534.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11534.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14127.3 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11534.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11534.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 11534.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11534.75, "additional_payer_notes": "100.00% 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": 14043, "minimum": 10045.1, "maximum": 24575.5475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17815.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15682.84 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18256.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 24575.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14043.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 14043.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14464.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 14043.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14043.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18256.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 18256.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12638.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14885.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 18256.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21766.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 14745.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21766.96, "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": 14745.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 14043.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18256.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 23171.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14043.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10045.1 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14043.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 14043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14043.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AICD CHECK SCHEDULED OP", "code_information": [ { "code": "93642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3868.08, "discounted_cash": 1217, "minimum": 194.9512, "maximum": 3573, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3573 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1582.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 2434.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2824.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3140.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3140.44 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1253.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1825.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1703.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1582.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1290.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1582.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1886.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 1277.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1886.49, "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": 1277.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1582.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2008.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1217.09, "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": 27630, "minimum": 18450, "maximum": 58219.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36938.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27630.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31170.76 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 35919.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 48353.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27630.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27630.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 27630.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27630.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28459.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 27630.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27630.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35919.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 35919.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24867.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29288.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 35919.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42827.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 29012.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42827.43, "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": 29012.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 27630.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 35919.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 27630.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27630.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 45590.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27630.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27630.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33928.7 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 27630.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27630.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 27630.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27630.58, "additional_payer_notes": "100.00% 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": 7788, "minimum": 7009.263, "maximum": 14850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7546.39 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10124.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 13629.12, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8021.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10124.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 10124.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7009.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8255.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 10124.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12071.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 8177.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12071.51, "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": 8177.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10124.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 12850.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7788.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9012.51 } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34479, "minimum": 19350, "maximum": 60339.615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 46577.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39966.95 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 44823.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 60339.62, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34479.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 34479.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35514.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 34479.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34479.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 44823.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 44823.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 31031.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36548.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 44823.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 53443.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 36203.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53443.69, "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": 36203.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 34479.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 44823.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 34479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 56891.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34479.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46479.3 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 34479.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 34479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34479.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADRENaline PF 1MG AMP", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00409724101", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 13.28, "10th_percentile": 13.28, "90th_percentile": 13.28, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5859, "minimum": 3305.82, "maximum": 10253.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6297.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5067.09 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7617.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 10253.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6035.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7617.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 7617.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5273.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6210.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 7617.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9081.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6152.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9081.82, "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": 6152.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7617.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 9667.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3305.82 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5859.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "alanine amino (ALT) (SGPT)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.47, "discounted_cash": 5, "minimum": 4.45, "maximum": 200.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.85 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "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": 9552, "minimum": 7637.05, "maximum": 16717.6975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11496.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9985.12 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12418.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 16717.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9839.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12418.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 12418.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8597.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10126.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 12418.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14807.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 10030.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14807.1, "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": 10030.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12418.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15762.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13364.6 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9552.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.55, "discounted_cash": 9, "minimum": 8.16, "maximum": 38.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 30.88 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.69 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.56 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "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": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% 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": 7215, "minimum": 6271.8408, "maximum": 13535.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8207.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6881.36 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9380.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 12627.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7432.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9380.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 9380.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6494.17, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7648.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 9380.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11184.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 7576.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11184.4, "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": 7576.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9380.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 11905.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8561.01 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7215.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERG SP IGE,QUAL,MULTIALLERG", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.6, "discounted_cash": 7, "minimum": 6.69, "maximum": 26.08, "payers_information": [ { "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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.34 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.91 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.91 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.58 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.4 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.91 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.58 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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" } ] } ] }, { "description": "ALKALINE PHOSPHATASE - 84075 - 405010215", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 369.9, "discounted_cash": 5, "minimum": 4.35, "maximum": 295.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN SERUM-CHRG ONLY", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161, "discounted_cash": 4, "minimum": 4.16, "maximum": 132.344, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.74 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.41 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.95 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "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": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERG SP IGG,QUAN OR SEMIQUAN", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.94, "discounted_cash": 7, "minimum": 6.41, "maximum": 43.152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.96 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "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": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE ISOENZYMES", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.75, "discounted_cash": 14, "minimum": 12.42, "maximum": 193.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 47 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.73 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.92 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.97 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.69 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN TESTING IGG", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.5, "discounted_cash": 7, "minimum": 6.41, "maximum": 43.152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.96 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "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": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN SPEC IGE, QUANT/SEMQ ALL", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 5, "minimum": 4.38, "maximum": 166.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.6 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.71 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 88561, "minimum": 79705.584, "maximum": 154983.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 122690.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 88561.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 101085.14 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 115130.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 154983.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 88561.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 88561.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 88561.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88561.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 91218.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 88561.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 88561.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 115130.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 115130.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 79705.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 93875.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 115130.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 137270.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 92989.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 137270.79, "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": 92989.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 88561.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 115130.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 88561.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 88561.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 146126.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88561.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 88561.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 100642 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 88561.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88561.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 88561.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88561.76, "additional_payer_notes": "100.00% 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": 11652, "minimum": 6306.58, "maximum": 34200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14451.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11653, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14189.62 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15148.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 20392.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11653, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11652.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 11652.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11653, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12002.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 11652.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11652.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15148.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 15148.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10487.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12352.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 15148.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18062.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 12235.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18062.15, "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": 12235.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 11652.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15148.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11653, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11653, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19227.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11653, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11652.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6306.58 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11652.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11653, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 11653, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11652.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL(ETHANOL)", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 394, "minimum": 1, "maximum": 315.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.27 }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.17 }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.14 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.7 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.73 } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6217, "minimum": 3784.8, "maximum": 14899.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6802.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5810.62 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8082.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 10880.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6404.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8082.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 8082.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5595.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6590.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 8082.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9637.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6528.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9637.26, "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": 6528.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8082.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 10259.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3784.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6217.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Alpha Subunit (Free)", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.82, "discounted_cash": 17, "minimum": 14.51, "maximum": 1200, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.46 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.95 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.34 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.84 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.92 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.22 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "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": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 } ] } ] }, { "description": "ALPHA-1-FETOPROTEIN", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.85, "discounted_cash": 16, "minimum": 14.09, "maximum": 154.128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.33 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.94 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.32 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "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": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.46 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE - 84075 - 405010220", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360, "discounted_cash": 5, "minimum": 4.35, "maximum": 295.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA-1-ANTITRYPSIN", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.2, "discounted_cash": 13, "minimum": 11.29, "maximum": 53.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.97 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.29 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.75, "discounted_cash": 40, "minimum": 34.23, "maximum": 163, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 116.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 129.59 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 25.38, "10th_percentile": 25.38, "90th_percentile": 25.38, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.06 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.49 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.01 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 52.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 36.28 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.03 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.66 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "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": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.06 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.49 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 67.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 34.23 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.57 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.05 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PROFILE,BASIC FOOD", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.55, "discounted_cash": 5, "minimum": 4.38, "maximum": 166.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.6 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.71 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA-GAL 1,3 IGE SERUM", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 17, "minimum": 4.075, "maximum": 16.3, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 15.06 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 15.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "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": 16.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.3 } ] } ] }, { "description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [ { "code": "80408", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 719.25, "discounted_cash": 125, "minimum": 105.42, "maximum": 575.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 251, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 358.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 399.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 399.09 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.46 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 188.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 105.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.14 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 111.75 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 194.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.67 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.84 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.53, "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": 131.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.46 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 105.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 207.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 105.42 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.05 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.42 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.56 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALKALOIDS,URINE,QUANTITATIVE", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.75, "minimum": 1, "maximum": 217.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.96 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.96 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.77 }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.96 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.69 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.77 }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.92 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.73 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.97 } ] } ] }, { "description": "AMIKACIN", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 15, "minimum": 12.5, "maximum": 47.9544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 47.95 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.72 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.92 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.26 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.72 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.19 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13582, "minimum": 6329.85, "maximum": 23769.4625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17167.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13582.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15646.68 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17657.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 23769.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13582.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13582.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 13582.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13582.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13989.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 13582.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13582.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17657.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 17657.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12224.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14397.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 17657.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21052.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 14261.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21052.88, "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": 14261.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 13582.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17657.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13582.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13582.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22411.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13582.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13582.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13194.1 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 13582.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13582.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 13582.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13582.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS,MULTI,QUAL,EA", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.66, "discounted_cash": 13, "minimum": 11.65, "maximum": 174.128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 44.11 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.65 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.07 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "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": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.65 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.36 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN TESTING IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.5, "discounted_cash": 5, "minimum": 4.38, "maximum": 166.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.6 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.71 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS,SGL,QUAN,EA", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.32, "discounted_cash": 22, "minimum": 19.3, "maximum": 256.256, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 45.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 65.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 73.08 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.53 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "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": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.17 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.35 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.37 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMMONIA - 82140 - 405018470", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 406.89, "discounted_cash": 14, "minimum": 12.24, "maximum": 325.512, "payers_information": [ { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.33 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.89 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.59 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS,SINGLE,QUAL,EA", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126, "discounted_cash": 14, "minimum": 11.91, "maximum": 100.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 45.09 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.63 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "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": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.9 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.68 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMNIOCENTESIS", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1674.12, "discounted_cash": 920, "minimum": 84.3756, "maximum": 1674.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 84.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 93.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 93.92 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1674.12 } ] } ] }, { "description": "AMMONIA - 82140 - 405018475", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396, "discounted_cash": 14, "minimum": 12.24, "maximum": 325.512, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.33 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.89 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.59 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA-2-ANTIPLASMIN", "code_information": [ { "code": "85410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.5, "discounted_cash": 7, "minimum": 6.48, "maximum": 50.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.52 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.15 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.87 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.26 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.94 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.95, "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": 8.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.15 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.48 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMNIOCENTESIS THRPTC AMNIO FLD", "code_information": [ { "code": "59001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 828.48, "minimum": 41.7554, "maximum": 828.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 828.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 176.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 195.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 195.61 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ALPHA-FETOPROTEIN,AMNIOTIC FLUID", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.75, "discounted_cash": 17, "minimum": 14.28, "maximum": 109.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.06 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.73 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "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": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.99 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMMONIA - 82140 - 405060050", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396, "discounted_cash": 14, "minimum": 12.24, "maximum": 325.512, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.33 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.89 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.59 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "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": 37086, "minimum": 27079.75, "maximum": 64900.7275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 50245.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37086.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42395.98 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 48211.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 64900.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37086.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37086.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 37086.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37086.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38198.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 37086.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37086.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48211.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 48211.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 33377.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39311.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 48211.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57483.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 38940.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57483.46, "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": 38940.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 37086.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 48211.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 37086.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37086.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 61192.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37086.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37086.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33909.9 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 37086.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37086.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 37086.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37086.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS 2-5, QUANT", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.5, "discounted_cash": 19, "minimum": 16.47, "maximum": 147.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 39.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 56.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 62.36 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 17.46 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.44 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "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": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.72 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.44 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.74 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMNIOTIC FLUID SPECTROPH", "code_information": [ { "code": "82143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.25, "discounted_cash": 9, "minimum": 7.85, "maximum": 49.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.73 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.68 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "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": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.41 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.61 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACID PROFILE QN PLASMA", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281.01, "discounted_cash": 16, "minimum": 14.17, "maximum": 249.4, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.49 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "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": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.63 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.17 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.65 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11426, "minimum": 10284.003, "maximum": 30331.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14133.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12258.04 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14854.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 19996.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11426.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 11426.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11769.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 11426.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11426.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14854.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 14854.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10284, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12112.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 14854.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17711.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 11998.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17711.39, "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": 11998, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 11426.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14854.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18854.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14361.2 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11426.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11426.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS,6/>,QUAN,EA", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.75, "discounted_cash": 16, "minimum": 14.17, "maximum": 249.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.65 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.49 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "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": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.63 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.17 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMIODARONE AND MET (CHROM QUAN", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 24, "minimum": 20.24, "maximum": 750, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 48.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 68.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 76.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.09 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 21.45 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.55 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.09 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.98 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.32 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.24 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMINOLEVULINIC ACID,URINE", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.15, "discounted_cash": 16, "minimum": 13.82, "maximum": 104.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 32.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 52.31 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.05 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.84 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.65 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.74 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "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": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.05 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.62 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.9 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.47 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMITRIPTYLINE, DRUG SCREEN", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "minimum": 1, "maximum": 125.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.35 } ] } ] }, { "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": 11672, "minimum": 10244.43, "maximum": 27430.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14479.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11672.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10244.43 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15174.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 20427.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11672.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11672.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 11672.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11672.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12022.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 11672.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11672.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15174.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 15174.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10505.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12372.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 15174.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18092.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 12256.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18092.53, "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": 12256.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 11672.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15174.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11672.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11672.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19259.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11672.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11672.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11842.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 11672.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11672.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 11672.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11672.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Amiodarone(Cordarone)Serum/Pla", "code_information": [ { "code": "80151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.2, "discounted_cash": 18, "minimum": 15.66, "maximum": 74.56, "payers_information": [ { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.74 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 37.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.28 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.22 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 16.6 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.04 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.7 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "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": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.22 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 30.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.16 } ] } ] }, { "description": "AMYLASE,BODY FLUID", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.71, "discounted_cash": 6, "minimum": 5.44, "maximum": 200.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "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": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINE/METHAMPH", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.75, "minimum": 1, "maximum": 112.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.57 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.81 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.04 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.39 }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.57 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.57 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.04 }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.52 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.62 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 } ] } ] }, { "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": 14951, "minimum": 13025.3, "maximum": 26164.8975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19093.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17503.29 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19436.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 26164.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14951.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 14951.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15399.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 14951.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14951.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19436.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 19436.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13456.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15848.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 19436.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23174.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 15698.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23174.67, "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": 15698.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 14951.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19436.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24669.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13025.3 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14951.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14951.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATE METATARSAL W/TOE SINGL", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7870.02, "discounted_cash": 3270, "minimum": 396.649, "maximum": 6541.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3914.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3914.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4100 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANA TITER", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237, "discounted_cash": 11, "minimum": 9.37, "maximum": 189.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.49 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.02 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.93 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "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": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.02 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.59 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.63 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMYLASE SERUM", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.71, "discounted_cash": 6, "minimum": 5.44, "maximum": 200.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "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": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% 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": 17892, "minimum": 16102.917, "maximum": 31311.2275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23232.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18916.25 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23259.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 31311.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17892.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 17892.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18428.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 17892.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17892.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23259.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 23259.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16102.92, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18965.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 23259.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27732.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 18786.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27732.76, "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": 18786.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 17892.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 23259.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 29522.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17892.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17916.3 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 17892.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 17892.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17892.13, "additional_payer_notes": "100.00% 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": 22061, "minimum": 13151.8, "maximum": 38607.9925, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29100.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22061.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24777.14 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28680.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 38607.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22061.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22061.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 22061.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22061.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22723.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 22061.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22061.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28680.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 28680.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19855.54, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23385.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 28680.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34195.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 23164.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34195.64, "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": 23164.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 22061.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 28680.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 22061.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22061.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 36401.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22061.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22061.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17857.2 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 22061.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22061.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 22061.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22061.71, "additional_payer_notes": "100.00% 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": 9945, "minimum": 7372.53, "maximum": 17404.4675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12048.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10380.26 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12929.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 17404.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10243.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12929.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 12929.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8950.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10542.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 12929.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15415.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 10442.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15415.39, "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": 10442.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12929.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16409.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7372.53 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9945.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANDROSTENEDI0NE LCMS", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.4, "discounted_cash": 29, "minimum": 24.6, "maximum": 117.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 58.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 83.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 93.11 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 38.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 26.08 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.33 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.93 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "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": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.48 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.44 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% 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": 32524, "minimum": 29272.356, "maximum": 56918.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43826.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32524.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37950.7 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 42282.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 56918.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 32524.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32524.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 32524.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32524.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33500.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 32524.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32524.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 42282.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 42282.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29272.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34476.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 42282.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 50413.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 34151.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50413.44, "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": 34151.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 32524.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 42282.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 32524.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32524.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 53665.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32524.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32524.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49427.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 32524.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32524.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 32524.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32524.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10878, "minimum": 9790.443, "maximum": 23673.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13361.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10878.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11478.35 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14141.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 19036.97, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10878.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10878.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11204.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14141.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 14141.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9790.44, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11531, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 14141.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16861.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 11422.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16861.37, "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": 11422.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14141.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10878.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10878.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17949.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10878.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11514.7 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10878.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 10878.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF FINGERTHUMB", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6386.62, "discounted_cash": 3270, "minimum": 321.8856, "maximum": 6386.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6386.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3914.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3914.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANDROSTERONE", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227, "discounted_cash": 25, "minimum": 21.46, "maximum": 181.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 73.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 81.25 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.56 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 22.75 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.18 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "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": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.56 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 42.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.33 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.87 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.66 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18036, "minimum": 8270.7, "maximum": 31563.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23435.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18036.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22483.06 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23447.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 31563.84, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18036.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18036.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 18036.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18036.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 18036.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18036.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23447.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 23447.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16232.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19118.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 23447.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27956.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 18938.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27956.58, "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": 18938.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 18036.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 23447.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18036.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18036.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 29760.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18036.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18036.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22510.9 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 18036.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18036.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 18036.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18036.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMYLASE, SERUM", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244, "discounted_cash": 6, "minimum": 5.44, "maximum": 200.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "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": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANCEF 3GM", "drug_information": { "unit": 3, "type": "GR" }, "code_information": [ { "code": "00264310511", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 47.91, "10th_percentile": 47.91, "90th_percentile": 47.91, "count": "1 through 10" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 6.3, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 1.34, "10th_percentile": 1.34, "90th_percentile": 1.34, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 1.96, "10th_percentile": 1.64, "90th_percentile": 1.96, "count": "1 through 10" } ] } ] }, { "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": 26681, "minimum": 17767.85, "maximum": 46693.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 35602.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34906.91 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 34686.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 46693.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26681.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 26681.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27482.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 26681.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26681.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 34686.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 34686.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24013.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28282.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 45000, "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": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 34686.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 41356.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 28015.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41356.79, "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": 28015.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 26681.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 34686.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 26681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 44024.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26681.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21038.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 26681.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 26681.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26681.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6475, "minimum": 5525.816, "maximum": 19809.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7165.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6157.24 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8418.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 11332.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6670.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8418.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 8418.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5828.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6864.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 8418.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10037.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6799.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10037.54, "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": 6799.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8418.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 10685.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5657.07 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6475.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANA-CHRG ONLY", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.45, "discounted_cash": 12, "minimum": 10.16, "maximum": 48.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.45 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.77 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.57 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.24 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO ADRENAL BILAT SEL RAD S&I", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 172.75, "maximum": 7924.56, "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.68 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.04 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 183.12 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 371.72 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.68 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.73 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 361.2 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.41 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7699, "minimum": 6323.72, "maximum": 14482.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8887.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8606.56 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10009.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 13474.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7930.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10009.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 10009.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6929.62, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8161.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 10009.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11934.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 8084.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11934.35, "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": 8084.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10009.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 12704.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6323.72 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7699.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO BRACH/RETROGRADE RT RAD S&I", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 150.36, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO ADRENAL BILAT SEL RAD S&", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 172.75, "maximum": 7924.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.68 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.04 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 183.12 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 371.72 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.68 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.73 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 361.2 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.41 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANALYSIS PROGRAM RE-PROGRAM", "code_information": [ { "code": "62368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 841.23, "discounted_cash": 307, "minimum": 42.398, "maximum": 841.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 841.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 614.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 104.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 115.75 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 316.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 399.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 399.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 475.88, "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": 322.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 399.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 506.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 307.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO EXT CAROT BILAT SLCT RAD - 36227 - 90062", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11653.7, "minimum": 214.638, "maximum": 9905.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ANGIO BRACH/RETROGRADE LT RAD S&I", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 150.36, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO ADRENAL,UNILAT SEL,RAD S - 75731 - 401090365", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 3156, "minimum": 153.7, "maximum": 3280.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 319.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 355.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 355.27 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 312.01 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.42 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 162.92 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.73 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "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": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 312.01 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.04 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.37 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANCEF 1 gm vial", "drug_information": { "unit": 1, "type": "GR" }, "code_information": [ { "code": "63323023710", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 47.91, "10th_percentile": 47.91, "90th_percentile": 47.91, "count": "1 through 10" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 6.3, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 1.34, "10th_percentile": 1.34, "90th_percentile": 1.34, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 1.96, "10th_percentile": 1.64, "90th_percentile": 1.96, "count": "1 through 10" } ] } ] }, { "description": "ANGIO EXT CAROTID UNIL SEL RAD - 36227 - 401090061", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4258.69, "minimum": 214.638, "maximum": 9905.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ANGIO CAROTID CEREB BILAT RAD - 36223 - 401090064", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 661.7318, "maximum": 19382.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO ADRENAL,UNILAT SEL,RAD S - 75731 - 90365", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 3156, "minimum": 153.7, "maximum": 3280.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 319.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 355.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 355.27 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 312.01 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.42 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 162.92 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.73 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "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": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 312.01 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.04 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.37 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANECTINE", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00409662925", "type": "NDC" }, { "code": "J0330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 102.18, "10th_percentile": 102.18, "90th_percentile": 102.18, "count": "1 through 10" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 14.07, "10th_percentile": 14.07, "90th_percentile": 14.07, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 17.56, "10th_percentile": 17.56, "90th_percentile": 17.56, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 23.75, "10th_percentile": 23.75, "90th_percentile": 27.96, "count": "1 through 10" } ] } ] }, { "description": "ANGIO EXTREMITY BILAT RAD S&I - 75716 - 401090069", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 163.05, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8505.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8505.98 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.9 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 172.83 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.57 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.85 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.99 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.05 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 340.92 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO CAROTID CERV LT RAD S&I - 36223 - 90356", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 661.7318, "maximum": 19382.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO AV SHUNT RAD S&I", "code_information": [ { "code": "36901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 1573, "minimum": 165.3569, "maximum": 5648.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2045.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3147.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 739.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 820.05 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 820.05 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1620.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2360.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2203, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2045.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1667.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2045.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2439.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 1652.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.03, "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": 1652.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2045.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2596.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1573.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO INTERNAL MAMMARY RAD S&I - 75756 - 401090375", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 165.4, "maximum": 7924.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 335.76 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.3 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.38 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.91 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 335.76 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.58 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 345.83 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.8 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO CAROTID/CERV BILAT RAD S - 36222 - 401090066", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 428.7014, "maximum": 11242.8, "payers_information": [ { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO BRACH/RETROGRADE LT RAD", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 150.36, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO CAROTID CERV LT RAD S&I - 36224 - 401090356", "code_information": [ { "code": "36224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 661.7318, "maximum": 17506.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO INTERNAL MAMMARY RAD S&I - 75756 - 90375", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 165.4, "maximum": 7924.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 335.76 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.3 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.38 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.91 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 335.76 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 165.4 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.58 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 345.83 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.8 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO CERV CEREB INC VESS RAD - 37221 - 90060", "code_information": [ { "code": "37221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29007.1, "discounted_cash": 11096, "minimum": 1461.9578, "maximum": 55635.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14424.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 22192.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11428.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16644.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15534.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14424.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11761.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14424.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17198.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 11650.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17198.92, "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": 11650.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14424.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 18308.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO BRACH/RETROGRADE RT RAD", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 150.36, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO CAROTID/CERV BILAT RAD S - 36222 - 90066", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 428.7014, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PELVIC SELECTIVE RAD S&I - 75736 - 401090367", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 143.68, "maximum": 13129.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.68 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 152.3 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.17 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.74 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.42 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.62 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO EXT CAROT BILAT SLCT RAD - 36227 - 401090062", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "minimum": 214.638, "maximum": 9905.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ANGIO CAROTID CEREB BILAT RAD - 36223 - 90064", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 661.7318, "maximum": 19382.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO CAROTID/CERV UNILAT RAD - 36222 - 90065", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 428.7014, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PULM ART NONSEL/VEN LT RAD", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 3156, "minimum": 134.99, "maximum": 3280.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 265.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 295.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 295.68 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.03 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 143.09 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.16 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.47 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "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": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.03 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.35 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO EXTREMITY BILAT RAD S&I - 75716 - 90069", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14053.5, "discounted_cash": 3156, "minimum": 163.05, "maximum": 11242.8, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.57 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.85 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.99 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.05 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 340.92 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.9 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 172.83 } ] } ] }, { "description": "ANGIO CAROTID/CERV UNILAT RAD - 36222 - 401090065", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 428.7014, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO EXT CAROTID UNIL SEL RAD - 36227 - 90061", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11653.7, "minimum": 214.638, "maximum": 9905.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ANGIO PULM ART SEL RT S&I - 75741 - 90371", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 129.98, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.06 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.69 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.86 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.78 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO POST INFUSION - 75898 - 401090084", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 3156, "minimum": 133.71, "maximum": 3280.89, "payers_information": [ { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.54 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.57 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.8 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 3128.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3280.89 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.43 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 141.73 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.72 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "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": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.43 } ] } ] }, { "description": "ANGIO CERV CEREB INC VESS RAD - 37221 - 401090060", "code_information": [ { "code": "37221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29007.1, "discounted_cash": 11096, "minimum": 1461.9578, "maximum": 55635.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14424.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 22192.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11428.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16644.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15534.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14424.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11761.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14424.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17198.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 11650.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17198.92, "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": 11650.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14424.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 18308.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11096.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO EXTREMITY RT RAD S&I - 75710 - 401090361", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 150.36, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8505.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8505.98 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PULM BILAT SLCT RAD S&I - 75743 - 401090074", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 147.69, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.81 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.18 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 302.14 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.8 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.81 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.47 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 308.81 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.59 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO SEL EA ADD VESSEL RAD S&I", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3623.69, "minimum": 182.634, "maximum": 2978.672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 189.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 210.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 } ] } ] }, { "description": "ANGIO EXTEMITY LT RAD S&I - 75710 - 401090362", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 150.36, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8505.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8505.98 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PELVIC SELECTIVE RAD S&I - 75736 - 90367", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 143.68, "maximum": 13129.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.68 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 152.3 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.17 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 143.68 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.74 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.42 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.62 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO RENAL BILAT SELECT RAD S", "code_information": [ { "code": "36252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 399.3978, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO VERT CRV&OR INTRCRN BIL - 36226 - 90357", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 661.7318, "maximum": 17506.08, "payers_information": [ { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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" } ] } ] }, { "description": "ANGIO EXTEMITY LT RAD S&I - 75710 - 90362", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14053.5, "discounted_cash": 3156, "minimum": 150.36, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PULM ART SEL RT S&I - 75741 - 401090371", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 129.98, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.06 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.69 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.86 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.78 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO SEL EA ADD VESSEL RAD S&", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3723.34, "minimum": 182.634, "maximum": 2978.672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 189.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 210.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 } ] } ] }, { "description": "ANGIOTENSION CONVERTING ENZYME", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.5, "discounted_cash": 14, "minimum": 12.26, "maximum": 137.2, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.38 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.63 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.43 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 } ] } ] }, { "description": "ANGIO EXTREMITY RT RAD S&I - 75710 - 90361", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18999.1, "discounted_cash": 3156, "minimum": 150.36, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 159.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.61 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 305.23 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 150.36 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.61 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PULM BILAT SLCT RAD S&I - 75743 - 90074", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14053.5, "discounted_cash": 3156, "minimum": 147.69, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.81 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.18 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 302.14 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.8 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.81 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 147.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.47 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 308.81 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.59 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery", "code_information": [ { "code": "29899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9668.01, "discounted_cash": 7253, "minimum": 487.2677, "maximum": 9668.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 9668.01, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7716.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8554.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8554.19 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9668.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9668.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7688.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9668.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": 9668.01, "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 9668.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO POST INFUSION - 75898 - 90084", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 3156, "minimum": 133.71, "maximum": 3280.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 3128.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3280.89 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.43 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 141.73 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.72 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "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": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.43 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 133.71 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.54 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.57 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.8 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO VERT CRV&OR INTRCRN BIL - 36226 - 401090357", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 661.7318, "maximum": 17506.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE DISLOCATION REDUCT W/O ANES", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1156.4, "discounted_cash": 246, "minimum": 58.2826, "maximum": 925.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 493.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 278.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 308.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 308.37 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.87, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 320.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 261.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 320.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 382.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PULM ART NONSEL/VEN LT R", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 3156, "minimum": 134.99, "maximum": 3280.89, "payers_information": [ { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 143.09 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.16 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.47 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "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": 3280.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.03 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.35 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 265.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 295.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 295.68 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 134.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.53 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.03 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO VISCERAL SELECT RAD S&I - 75726 - 90072", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24228.7, "discounted_cash": 5562, "minimum": 170.08, "maximum": 19382.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13145.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14615.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14615.88 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 345.26 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 180.28 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.95 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 365.98 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 345.26 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.59 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.62 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.1 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE/FOOT STRAPPING", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.86, "discounted_cash": 162, "minimum": 18.1503, "maximum": 403.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 403.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 20.12 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 403.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI GLIADIN IGM AB", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 11, "minimum": 7.5, "maximum": 2796, "payers_information": [ { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.66 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.26 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "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": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 } ] } ] }, { "description": "ANGIO PULM ART SEL LT S&I - 75741 - 401090372", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3156, "minimum": 129.98, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7924.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.06 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.69 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.86 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.78 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGTEGRADE UROGRAM RAD S&I - 74425 - 401090350", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1157.64, "discounted_cash": 348, "minimum": 135.99, "maximum": 1543.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1157.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 453.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 697.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1092.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1157.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1157.64 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 523.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.3 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 453.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 369.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 453.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 144.15 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 540.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 366.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.62 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.06 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 261.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.34 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 270.33 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Anoscopy", "code_information": [ { "code": "46611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5575.02, "discounted_cash": 929, "minimum": 280.981, "maximum": 4460.016, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1208.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1859.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 985.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1092.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1092.35 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1394.42, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1208.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 985.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1208.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1440.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-PHOSPHATIDYLSERINE AB IGG", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.75, "discounted_cash": 16, "minimum": 13.5, "maximum": 106.4, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.1 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.41 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.31 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.62 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.05 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.41 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.23 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 45.96 } ] } ] }, { "description": "ANGIO PULM ART SEL LT S&I - 75741 - 90372", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14053.5, "discounted_cash": 3156, "minimum": 129.98, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.86 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.06 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.69 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.86 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 129.98 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.78 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Anoscopy and biopsy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12431.4, "discounted_cash": 1196, "minimum": 275.6085, "maximum": 9945.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1555.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 2392.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 275.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 305.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 305.52 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1232.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1794.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1674.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1555.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1267.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1555.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1854.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 1256.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1854.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1256.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1555.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1973.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1196.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI GLIADIN IGG AB", "code_information": [ { "code": "86231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.76, "discounted_cash": 12, "minimum": 10.16, "maximum": 127.808, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.45 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.77 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.57 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.24 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-PHOSPHATIDYLSERINE AB IGM", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133, "discounted_cash": 16, "minimum": 13.5, "maximum": 106.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 45.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.1 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.41 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.31 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.62 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.05 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.41 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.23 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO RENAL SEL LT RAD S&I", "code_information": [ { "code": "36251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 399.3978, "maximum": 10566.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-RIBONUCLEIC ACID AB", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.9, "discounted_cash": 17, "minimum": 14.51, "maximum": 1200, "payers_information": [ { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.95 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.34 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.84 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.92 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.22 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "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": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.46 } ] } ] }, { "description": "ANTI-THROMBIN III", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.36, "discounted_cash": 11, "minimum": 9.95, "maximum": 214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 37.68 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.61 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.55 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.41 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.8 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO RENAL SEL RT RAD S&I", "code_information": [ { "code": "36251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 399.3978, "maximum": 10566.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY ID,LEUKOCYTE", "code_information": [ { "code": "86021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.1, "discounted_cash": 15, "minimum": 12.64, "maximum": 184.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 47.86 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.4 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.86 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.2 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.43 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY ID,PATIENT", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1584.75, "discounted_cash": 358, "minimum": 14.4648, "maximum": 1267.8, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 369.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 537.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 379.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "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": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 591.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 716.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 810.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 901.24 } ] } ] }, { "description": "ANGIO VERT CRV&OR INTRCRN LT R - 36226 - 401090359", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 661.7318, "maximum": 17506.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN - 86850 - 405035010", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.9, "discounted_cash": 52, "minimum": 5.6115, "maximum": 191.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 104.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.31 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 143.34, "10th_percentile": 135, "90th_percentile": 143.34, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 23.24, "10th_percentile": 18.6, "90th_percentile": 23.24, "count": "19" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 54.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 20.93, "10th_percentile": 19.71, "90th_percentile": 24.63, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 28.73, "10th_percentile": 28.73, "90th_percentile": 30.5, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.72, "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": 54.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 8.27, "10th_percentile": 8.27, "90th_percentile": 8.27, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 13.56, "10th_percentile": 13.56, "90th_percentile": 15.96, "count": "13" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 19.77, "10th_percentile": 19.77, "90th_percentile": 19.77, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 85.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 19.16, "10th_percentile": 19.16, "90th_percentile": 19.16, "count": "1 through 10" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% 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": 51276, "minimum": 12929.4, "maximum": 89733.6125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 70216.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51276.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60458.45 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 66659.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 89733.61, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 51276.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 51276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51276.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 52814.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 51276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 66659.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 66659.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 46148.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 54352.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 66659.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 79478.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 53840.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 79478.27, "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": 53840.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 51276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 66659.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 51276.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51276.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 84605.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51276.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12929.4 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 51276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51276.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 51276.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51276.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO VERT CRV&OR INTRCRN LT R - 36226 - 90359", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 661.7318, "maximum": 17506.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN- CHRG ONLY", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225, "discounted_cash": 52, "minimum": 5.6115, "maximum": 191.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 104.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.31 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 143.34, "10th_percentile": 135, "90th_percentile": 143.34, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 23.24, "10th_percentile": 18.6, "90th_percentile": 23.24, "count": "19" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 54.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 20.93, "10th_percentile": 19.71, "90th_percentile": 24.63, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 28.73, "10th_percentile": 28.73, "90th_percentile": 30.5, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.72, "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": 54.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 8.27, "10th_percentile": 8.27, "90th_percentile": 8.27, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 13.56, "10th_percentile": 13.56, "90th_percentile": 15.96, "count": "13" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 19.77, "10th_percentile": 19.77, "90th_percentile": 19.77, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 85.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 19.16, "10th_percentile": 19.16, "90th_percentile": 19.16, "count": "1 through 10" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO VISCERAL SELECT RAD S&I - 75726 - 401090072", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21882.6, "discounted_cash": 5562, "minimum": 170.08, "maximum": 19382.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13145.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14615.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14615.88 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 345.26 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 180.28 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.95 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 365.98 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 345.26 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 170.08 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.59 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.62 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.1 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI TRANSGLUTAMINASE IGG AB", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.76, "discounted_cash": 11, "minimum": 7.5, "maximum": 2796, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "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": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.66 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.26 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN TYPING CLASS II", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.79, "discounted_cash": 358, "minimum": 4.7, "maximum": 1267.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 80.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.79 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "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": 80.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9687, "minimum": 8550, "maximum": 16953.8075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11686.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9817.54 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12594.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 16953.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9978.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12594.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 12594.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8719.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10269.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8550, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 4500, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 12594.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15016.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 10172.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15016.23, "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": 10172.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12594.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15985.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14414.3 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9687.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIOTENSIN II", "code_information": [ { "code": "82163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.75, "discounted_cash": 20, "minimum": 17.24, "maximum": 94.2, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.21 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.05 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.27 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 41.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.27 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.27 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 18.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 21.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.1 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "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": 21.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.27 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.19 } ] } ] }, { "description": "ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1584.75, "discounted_cash": 358, "minimum": 14.4648, "maximum": 1267.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 716.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 810.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 369.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 537.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 379.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "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": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 591.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Antigen typing class III", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 881.8, "discounted_cash": 358, "minimum": 4.7, "maximum": 1267.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 716.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 810.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 881.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 881.8 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 369.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 537.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 379.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "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": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 591.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPLY DERMAGRAFT 1ST 100 SQ CM", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4646.88, "discounted_cash": 2062, "minimum": 234.2028, "maximum": 8785.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2681.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 4125.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2093.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2320.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2320.52 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3093.78, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2681.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2186.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2681.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3196.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2062.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGTEGRADE UROGRAM RAD S&I - 74425 - 90350", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1157.64, "discounted_cash": 348, "minimum": 135.99, "maximum": 1543.52, "payers_information": [ { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 453.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 144.15 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 540.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 366.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.62 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.06 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 261.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.34 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 270.33 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1157.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 453.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 697.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1092.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1157.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1157.64 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 348.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 523.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 135.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.3 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 453.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 369.66, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN - 86850 - 405039525", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.9, "discounted_cash": 52, "minimum": 5.6115, "maximum": 191.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 104.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.48 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.31 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 54.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.72, "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": 54.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 85.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN TYPING DONOR", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.79, "discounted_cash": 358, "minimum": 4.7, "maximum": 1267.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 80.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.79 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "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": 80.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPLY FOREARM SPLINT DYNAMIC", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.44, "discounted_cash": 133, "minimum": 16.0998, "maximum": 319.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 319.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 266, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 140.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 155.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 155.91 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 319.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN-GEL", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.34, "discounted_cash": 52, "minimum": 5.6115, "maximum": 191.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 104.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.34 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 111.34 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 54.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.72, "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": 54.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 67.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 85.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIHUMAN GLOBULIN TEST", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154, "discounted_cash": 58, "minimum": 4.53, "maximum": 215.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 95.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 106.31 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.73 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.01 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APRESOLine 20MG INJ", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00517090125", "type": "NDC" }, { "code": "J0360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 99.39, "10th_percentile": 99.39, "90th_percentile": 99.39, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 21.18, "10th_percentile": 5.59, "90th_percentile": 21.18, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 7.87, "10th_percentile": 7.87, "90th_percentile": 7.87, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 8.28, "10th_percentile": 8.28, "90th_percentile": 8.28, "count": "1 through 10" }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 17.46, "10th_percentile": 17.46, "90th_percentile": 17.46, "count": "1 through 10" } ] } ] }, { "description": "ANTIBODY TITER - 86886 - 405035005", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163, "discounted_cash": 170, "minimum": 4.35, "maximum": 163, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 163 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 163 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 163 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "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": 163, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Antimyeloperoxidase(MPO)Antibo", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30, "discounted_cash": 11, "minimum": 7.5, "maximum": 2796, "payers_information": [ { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "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": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.66 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.26 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 30 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Arterial Embolization w/S&I", "code_information": [ { "code": "37242", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77311.4, "discounted_cash": 18324, "minimum": 1330, "maximum": 61849.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 36649.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18874.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27487.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25654.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19424.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28403.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 19241.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28403.66, "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": 19241.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 30236.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY,HIV-1(SUDS)", "code_information": [ { "code": "86698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.5, "discounted_cash": 13, "minimum": 11.58, "maximum": 121.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 27.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.44 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.35 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.65 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.92 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.37, "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": 14.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.35 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.51 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.21 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.02 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIPSYCHOTICS 4-6", "code_information": [ { "code": "80343", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160, "minimum": 1, "maximum": 128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 27.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.13 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.79 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 28.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.56 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.44 }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 27.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 27.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.31 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.79 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.99 } ] } ] }, { "description": "ARTH APSIR&INJ JNT BURSA W/US", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1231.75, "discounted_cash": 306, "minimum": 59.9059, "maximum": 985.4, "payers_information": [ { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 67.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 74.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 74.83 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% 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" } ] } ] }, { "description": "ANTINUCLEAR ANITBODIES (ANA)", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.45, "discounted_cash": 12, "minimum": 10.16, "maximum": 48.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.45 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.77 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.57 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.24 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTISTREPTOLYSIN O TITER", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.71, "discounted_cash": 7, "minimum": 6.13, "maximum": 30.168, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.21 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.44 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "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": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.44 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHCEN/ASP/LARGE JNT/BURSA/GA", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.85, "discounted_cash": 306, "minimum": 40.0416, "maximum": 6659.232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 40.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 44.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 44.39 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTISTREPTOLYSIN O,SCREEN", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.5, "discounted_cash": 5, "minimum": 4.85, "maximum": 83.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.14 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.92 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.44 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.85 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.14 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% 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": 32019, "minimum": 5877.29, "maximum": 56033.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43114.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32019.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36678.85 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 41625.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 56033.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 32019.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32019.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 32019.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32019.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 32979.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 32019.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32019.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41625.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 41625.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 28817.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33940.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 41625.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49629.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 33620.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49629.76, "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": 33620.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 32019.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 41625.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 32019.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32019.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 52831.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32019.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32019.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5877.29 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 32019.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32019.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 32019.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32019.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd ant ntrbdy cervical", "code_information": [ { "code": "22551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25068.4, "discounted_cash": 12833, "minimum": 1263.4474, "maximum": 25068.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 25068.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15351.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17018.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17018.02 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19250.97, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13604.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19892.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AORTOGR ABD-SERIALOGR RAD S&I - 75625 - 90059", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14053.5, "discounted_cash": 3156, "minimum": 126.64, "maximum": 11242.8, "payers_information": [ { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 236.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.08 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.92 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.79 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 251.75 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.08 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 236.82 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 134.24 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 259.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 272.5 } ] } ] }, { "description": "apolopoprotein", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.47, "discounted_cash": 21, "minimum": 17.72, "maximum": 112.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 67.07 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.97 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 485.45, "10th_percentile": 485.45, "90th_percentile": 485.45, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 18.78 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.13 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.97 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 34.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.23 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASCORBIC ACID,BLOOD", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.75, "discounted_cash": 9, "minimum": 8.31, "maximum": 46.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 31.45 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.31 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.81 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "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": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.31 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.01 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.38 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.52 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI TRANSGLUTAMINASE IGM AB", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.5, "discounted_cash": 11, "minimum": 7.5, "maximum": 2796, "payers_information": [ { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.66 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.26 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "AORTOGR THORAC SERIALOGR RAD S", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13167.2, "discounted_cash": 5562, "minimum": 120.95, "maximum": 13167.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13145.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13167.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13167.2 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.53 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.18 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 128.21 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 247.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.26 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.53 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.96 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.89 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.44 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASP ABSC HEMATOMA BULLA/CYST", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4052.4, "discounted_cash": 406, "minimum": 72.4122, "maximum": 3241.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 812.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 107.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 119.22 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 119.22 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 418.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 609.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 528.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 430.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 528.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 629.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 426.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.86, "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": 426.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 528.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 670.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY ELUTION-CHRG ONLY", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 753.05, "discounted_cash": 170, "minimum": 29.18, "maximum": 602.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 340.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 410.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 456.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 456.33 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 263.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AORTOGR THORAC SERIALOGR RAD S&I", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 5562, "minimum": 120.95, "maximum": 13167.2, "payers_information": [ { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.53 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.18 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 128.21 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 247.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.26 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.53 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 120.95 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.96 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.89 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.44 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13129.6 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Aspergillus Fumigatus IgA", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.8, "discounted_cash": 17, "minimum": 14.51, "maximum": 1200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.92 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.22 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "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": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.46 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.95 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.34 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.84 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN (INDIRECT COOMBS)", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73, "discounted_cash": 170, "minimum": 4.8, "maximum": 73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 73 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.25 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APLIGRAF/ORCEL APPL 1ST 25", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4646.88, "discounted_cash": 738, "minimum": 234.2028, "maximum": 6432.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1477.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2093.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2320.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2320.52 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1145.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12363, "minimum": 11127.492, "maximum": 22409.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15452.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13347.31 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16073.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 21636.79, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12363.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 12363.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12734.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 12363.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12363.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16073.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 16073.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11127.49, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13105.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 16073.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19164.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 12982.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19164.05, "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": 12982.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 12363.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16073.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20400.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12363.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22409.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12363.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 12363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12363.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Aspir and/or Injec Small Joint", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1857.98, "discounted_cash": 306, "minimum": 32.121, "maximum": 1486.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 32.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 35.61 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 35.61 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY TITER - 86886 - 405066150", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163, "discounted_cash": 170, "minimum": 4.35, "maximum": 163, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 163 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 163 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 163 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "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": 163, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPL SKIN SUBSTITUTE ADD'L 25S", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.75, "minimum": 12.6207, "maximum": 519.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 519.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 519.75 } ] } ] }, { "description": "ASSAY IGA/IGD/IGG/IGM EACH", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127, "discounted_cash": 9, "minimum": 7.81, "maximum": 105.6, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.57 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.28 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.81 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "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": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.04 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.53 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN TYPING CLASS I", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1584.75, "discounted_cash": 358, "minimum": 4.7, "maximum": 1267.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 716.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 810.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 369.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 537.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 379.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "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": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 591.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPL. FINGER SPLINT,STATIC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 563.2, "discounted_cash": 133, "minimum": 28.3853, "maximum": 563.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 563.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 266, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 70.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 78.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 78.66 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 46.56, "10th_percentile": 32.34, "90th_percentile": 54.79, "count": "1 through 10" }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 139.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 34.28, "10th_percentile": 34.28, "90th_percentile": 49.35, "count": "1 through 10" }, { "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 563.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 56.41, "10th_percentile": 56.41, "90th_percentile": 56.41, "count": "1 through 10" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN TYPING PATIENT", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1584.75, "discounted_cash": 358, "minimum": 3.22, "maximum": 1267.8, "payers_information": [ { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 379.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.41 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.38, "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": 376.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 591.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.4 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 716.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 810.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 369.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 358.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 537.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.63, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "APPLY FINGER SPLINT DYNAMIC", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.78, "discounted_cash": 58, "minimum": 12.4881, "maximum": 247.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 247.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 70.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 78.66 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 78.66 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 247.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATArax 50MG INJ", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00517560125", "type": "NDC" }, { "code": "J3410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 65.1, "10th_percentile": 49.98, "90th_percentile": 69.31, "count": "1 through 10" } ] } ] }, { "description": "ANTIGEN TYPING,RARE (SERUM SCR", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.06, "discounted_cash": 358, "minimum": 3.22, "maximum": 1267.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 74.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.06 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 74.06 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.41 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "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": 74.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.4 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPL SKINSUB GRAFT LOW 100SQCM", "code_information": [ { "code": "C5273", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8746.3, "discounted_cash": 1789, "minimum": 1161, "maximum": 6997.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2326.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3579.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2093.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2320.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2320.52 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1843.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2684.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2505.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2326.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1897.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2326.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2774.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 1879.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2774.17, "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": 1879.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2326.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2953.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1789.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APTT, B - CHRG ONLY", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207, "discounted_cash": 4, "minimum": 3.6, "maximum": 170.152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 124.2, "10th_percentile": 124.2, "90th_percentile": 124.2, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.82 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "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": 4.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHEREC W/PTCA INIT", "code_information": [ { "code": "92924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29007.1, "discounted_cash": 11539, "minimum": 1455.7334, "maximum": 23205.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4708 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23079.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11886.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17309.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16155.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12232.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "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": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19040.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGLOMERULAR BAS MEMBRANE AB", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.65, "discounted_cash": 11, "minimum": 7.5, "maximum": 2796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "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": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.66 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.26 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPLICATION TOTAL CONTACT CAST", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 279, "minimum": 35.6197, "maximum": 706.74, "payers_information": [ { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 706.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 706.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 363.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 559.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 80.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 88.76 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 88.76 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 279.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.37, "additional_payer_notes": "150.00% 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" } ] } ] }, { "description": "ARTERIAL PTA EA ADD", "code_information": [ { "code": "37247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22696.1, "minimum": 132.4905, "maximum": 18156.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "ATHRC BRACHIOCEPHALIC TRUNK - 0237T - 401091614", "code_information": [ { "code": "0237T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35791.4, "discounted_cash": 11539, "minimum": 1330, "maximum": 28633.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23079.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11886.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17309.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16155.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12232.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "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": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19040.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Antiproteinase 3(PR3)Antibodie", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30, "discounted_cash": 11, "minimum": 7.5, "maximum": 2796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 30 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "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": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.66 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.26 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL PTA INIT", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25425, "discounted_cash": 5689, "minimum": 707.3942, "maximum": 20340, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2596 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7396.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11378.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6390.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7084.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7084.09 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5860.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8534.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7965.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7396.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6030.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7396.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8818.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5973.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8818.68, "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": 5973.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7396.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 9387.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5689.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHCEN/ASP/INJ/INTERMED JNT/B", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.4, "discounted_cash": 306, "minimum": 33.5142, "maximum": 1486.384, "payers_information": [ { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 33.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 37.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 37.15 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHRC COMMON/INTRNL/EXTRNL ILI - 0238T - 401091615", "code_information": [ { "code": "0238T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48061.2, "discounted_cash": 18324, "minimum": 2422.2845, "maximum": 39567.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 36649.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20562.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22794.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 22794.16 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18874.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27487.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25654.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19424.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28403.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 19241.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28403.66, "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": 19241.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 30236.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AORTOGR ABD-SERIALOGR RAD S&I - 75625 - 401090059", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 3156, "minimum": 126.64, "maximum": 11242.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8505.98 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8505.98 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.08 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 236.82 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 134.24 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 259.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 272.5 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 236.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.08 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 126.64 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.92 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.79 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 251.75 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Artery-vein autograft", "code_information": [ { "code": "36825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23488.6, "discounted_cash": 5562, "minimum": 1183.8254, "maximum": 18790.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRO/ELBOW/EXPLOR/DRAIN/REM FB", "code_information": [ { "code": "24000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7870.02, "discounted_cash": 3270, "minimum": 396.649, "maximum": 6541.6, "payers_information": [ { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3914.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3914.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHRC RENAL ARTERY - 0234T - 91611", "code_information": [ { "code": "0234T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35791.4, "discounted_cash": 11539, "minimum": 1330, "maximum": 28633.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23079.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11886.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17309.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16155.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12232.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "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": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19040.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AORTOGR ABD/BIL ILEOFIM LE RAD", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18999.1, "discounted_cash": 3156, "minimum": 157.04, "maximum": 15199.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7925.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8812.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.09 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.09 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.79 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.66 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 166.46 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 337.92 }, { "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.09 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.79 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 302.47 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.35 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 312.18 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Artery-vein nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19357, "discounted_cash": 5562, "minimum": 975.5928, "maximum": 15485.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 4875.58, "10th_percentile": 4875.58, "90th_percentile": 4875.58, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11697.08, "maximum": 28694.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11697.08 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16708.2 } ] } ] }, { "description": "APIR/INJ REN/PELVIS W/NDL PERC - 50390 - 401090339", "code_information": [ { "code": "50390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1738.02, "discounted_cash": 707, "minimum": 87.5962, "maximum": 2481.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 786.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 872.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 872.31 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 991, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 750.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1167.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1738.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHOCENTESIS JOINT BURSA W/US", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1188.61, "discounted_cash": 306, "minimum": 59.9059, "maximum": 985.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 67.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 74.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 74.83 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.25, "discounted_cash": 15, "minimum": 12.64, "maximum": 60.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 47.86 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.4 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.86 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.2 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.43 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APIR/INJ REN/PELVIS W/NDL PERC - 50390 - 90339", "code_information": [ { "code": "50390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1738.02, "discounted_cash": 707, "minimum": 87.5962, "maximum": 2481.6, "payers_information": [ { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1167.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1738.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 786.91 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 872.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 872.31 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 991, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 750.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Aspir and/or Injec Large Joint", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1909.07, "discounted_cash": 306, "minimum": 40.0416, "maximum": 6659.232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 40.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 44.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 44.39 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Av fuse uppr arm basilic", "code_information": [ { "code": "36819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18749.4, "discounted_cash": 5562, "minimum": 944.9698, "maximum": 14999.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APLIGRAF/ORCEL APPL EA ADD 25", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.75, "minimum": 12.6207, "maximum": 519.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 519.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 519.75 } ] } ] }, { "description": "ATHEREC W/PTCA ADD'L", "code_information": [ { "code": "92925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26164.6, "minimum": 1318.6958, "maximum": 20931.68, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 } ] } ] }, { "description": "ASPIRATE PLEUA W/IMAGING", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2760.2, "discounted_cash": 627, "minimum": 93.7455, "maximum": 2548.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 815.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1254.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 813.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 901.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 901.63 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 645.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 940.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 877.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 815.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 664.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 815.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 971.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 658.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 971.96, "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": 658.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 815.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1034.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AZITHROMYCIN 500MG+NS 250ML", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "63323039810", "type": "NDC" }, { "code": "J0456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 3.58, "10th_percentile": 3.58, "90th_percentile": 3.58, "count": "1 through 10" } ] } ] }, { "description": "APOLIPOPROTEIN, A-1", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.25, "discounted_cash": 21, "minimum": 17.72, "maximum": 112.2, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.13 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.97 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 34.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.23 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 67.07 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.97 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 18.78 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "ATHEREC W/STENT W/PTCA INIT", "code_information": [ { "code": "92933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46063.5, "discounted_cash": 18324, "minimum": 2321.6004, "maximum": 36850.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6939 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 36649.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20562.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22794.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 22794.16 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18874.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27487.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25654.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19424.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28403.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 19241.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28403.66, "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": 19241.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 30236.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF LDH ENZYMES", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125, "discounted_cash": 12, "minimum": 10.74, "maximum": 122.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 25.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.58 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.67 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.67 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.8 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.08 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "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": 13.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.8 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.46 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.35 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACT CULT-QUAN,ANAEROBIC", "code_information": [ { "code": "87073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.75, "discounted_cash": 9, "minimum": 8.11, "maximum": 66.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.45 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "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": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.62 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.96 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHRC ABDOMINAL AORTA - 0236T - 401091613", "code_information": [ { "code": "0236T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35791.4, "discounted_cash": 11539, "minimum": 1330, "maximum": 28633.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23079.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11886.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17309.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16155.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12232.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "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": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19040.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHEREC W/STENT W/PTCA ADD'L", "code_information": [ { "code": "92934", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20841.2, "minimum": 1050.3965, "maximum": 16672.96, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 } ] } ] }, { "description": "ATHRC COMMON/INTRNL/EXTRNL ILI - 0238T - 91615", "code_information": [ { "code": "0238T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49459.8, "discounted_cash": 18324, "minimum": 2422.2845, "maximum": 39567.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 36649.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20562.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22794.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 22794.16 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18874.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27487.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25654.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19424.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28403.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 19241.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28403.66, "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": 19241.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23822.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 30236.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18324.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10064, "minimum": 7173.45, "maximum": 17612.6475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12216.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10064.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9888.1 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13083.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 17612.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10064.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10064.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 10064.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10064.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10366.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 10064.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10064.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13083.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 13083.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9057.93, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10668.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 13083.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15599.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 10567.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15599.82, "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": 10567.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 10064.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13083.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10064.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10064.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16606.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10064.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10064.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11064.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10064.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10064.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 10064.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10064.37, "additional_payer_notes": "100.00% 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": 26913, "minimum": 24222.501, "maximum": 47099.3075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 35929.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31952.21 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 34988.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 47099.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26913.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 26913.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27721.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 26913.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26913.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 34988.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 34988.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24222.5, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28528.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 34988.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 41716.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 28259.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41716.55, "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": 28259.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 26913.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 34988.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 26913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 44407.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26913.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28275.1 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 26913.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 26913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26913.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18756, "minimum": 16881.12, "maximum": 32824.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24449.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19815.01 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24383.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 32824.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19319.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24383.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 24383.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16881.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19882.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 24383.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29073.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 19694.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29073.04, "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": 19694.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 24383.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 30948.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24922.1 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18756.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHRC RENAL ARTERY - 0234T - 401091611", "code_information": [ { "code": "0234T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35791.4, "discounted_cash": 11539, "minimum": 1330, "maximum": 28633.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23079.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11886.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17309.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16155.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12232.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "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": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19040.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6267, "minimum": 4464.31, "maximum": 14970.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6872.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5804.44 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8147.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 10968.37, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6455.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8147.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 8147.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5640.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6643.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 8147.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9714.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6581.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9714.84, "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": 6581.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8147.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 10341.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4464.31 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6267.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA ANTIBODY", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112, "discounted_cash": 10, "minimum": 8.55, "maximum": 89.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "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": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPL BILAMINATE SK SUB 25 SQ C", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8040.2, "discounted_cash": 738, "minimum": 234.2028, "maximum": 6432.16, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2320.52 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1145.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 960.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1477.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2093.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2320.52 } ] } ] }, { "description": "ATHRC VISCERAL ARTERY - 0235T - 401091612", "code_information": [ { "code": "0235T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15966.4, "minimum": 804.7066, "maximum": 12773.12, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1394.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1545.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1545.89 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "BARTONELLA HENSELAE ANTIBODY", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.32, "discounted_cash": 10, "minimum": 8.55, "maximum": 89.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "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": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112427.87, "discounted_cash": 12833, "minimum": 1330, "maximum": 89942.296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 25667.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15351.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17018.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17018.02 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19250.97, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13604.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19892.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHRC VISCERAL ARTERY - 0235T - 91612", "code_information": [ { "code": "0235T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15966.4, "minimum": 804.7066, "maximum": 12773.12, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1394.54 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1545.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1545.89 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44398, "minimum": 39958.326, "maximum": 77696.745, "payers_information": [ { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 44398.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44398.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 60536.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44398.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54481.14 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 57717.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 77696.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44398.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44398.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 44398.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44398.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45730.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 44398.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44398.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 57717.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 57717.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 39958.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47061.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 57717.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 68817.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 46618.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68817.06, "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": 46618.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 44398.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 57717.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 44398.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 44398.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 73256.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44398.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44398.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43039.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 44398.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44398.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16438, "minimum": 10519.8, "maximum": 28767.2525, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21186.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14832.59 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21369.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 28767.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16438.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 16438.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16931.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 16438.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16438.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21369.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 21369.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14794.59, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17424.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 21369.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25479.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 17260.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25479.52, "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": 17260.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 16438.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21369.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27123.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16438.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10519.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 16438.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 16438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16438.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPLICATION OF STRAPPING", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 694.7, "discounted_cash": 162, "minimum": 35.0129, "maximum": 694.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 694.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 54.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 60.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 60.37 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 694.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40790, "minimum": 36711.009, "maximum": 73350, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 55458.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40790, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54481.14 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 53027.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 71382.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 40790, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40790.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 40790.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40790, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42013.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 40790.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40790.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53027.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 53027.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 36711.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43237.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 53027.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 63224.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 42829.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 63224.5, "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": 42829.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 40790.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 53027.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 40790, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40790, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 67303.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40790, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40790.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57408.7 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 40790.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40790, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 40790, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40790.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AV FISTULA BANDING/LIGATION", "code_information": [ { "code": "37607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13040, "discounted_cash": 3156, "minimum": 657.216, "maximum": 13103.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6621, "minimum": 3338.37, "maximum": 14087.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7370.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6446.54 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8608.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 11587.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6820.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8608.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 8608.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5959.48, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7018.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 8608.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10263.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6952.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.54, "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": 6952.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8608.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 10925.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3338.37 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6621.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPLY DERMAGRAFT ADDTL 100 SQ", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591, "minimum": 29.7864, "maximum": 698.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 591 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 591 } ] } ] }, { "description": "Av fistula revision", "code_information": [ { "code": "36833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15589.9, "discounted_cash": 5562, "minimum": 785.731, "maximum": 12471.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BENTYL 20MG INJ", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "58914008052", "type": "NDC" }, { "code": "J0500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 393.27, "10th_percentile": 393.27, "90th_percentile": 393.27, "count": "1 through 10" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 33.03, "10th_percentile": 33.03, "90th_percentile": 33.03, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 83.67, "10th_percentile": 71.07, "90th_percentile": 83.67, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 20.33, "10th_percentile": 20.33, "90th_percentile": 40.95, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 20.33, "10th_percentile": 20.33, "90th_percentile": 30.25, "count": "1 through 10" } ] } ] }, { "description": "APPLY MULTI LYR COMP LWR LEG", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.29, "discounted_cash": 162, "minimum": 38.873, "maximum": 771.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 771.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 324.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 87.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 96.64 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 96.64 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.66, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 211.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 771.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Av fistula revision open", "code_information": [ { "code": "36832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19843.1, "discounted_cash": 5562, "minimum": 1000.0922, "maximum": 15874.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% 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": 41447, "minimum": 31950, "maximum": 72533.9125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 56384.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41447.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60139.17 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 53882.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 72533.91, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 41447.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41447.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 41447.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41447.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42691.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 41447.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41447.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53882.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 53882.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 37303.16, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43934.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 53882.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 64244.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 43520.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 64244.25, "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": 43520.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 41447.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 53882.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 41447.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41447.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 68389.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41447.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41447.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58367.6 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 41447.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41447.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 41447.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41447.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APTT MIX 1-1 - CHRG ONLY", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244, "discounted_cash": 6, "minimum": 5.05, "maximum": 200.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.19 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 146.4, "10th_percentile": 146.4, "90th_percentile": 146.4, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.25 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.87 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "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": 6.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.25 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 5.05 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.73 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AVULSION OF NAIL PLATE,SIMP/SI", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1269.12, "discounted_cash": 200, "minimum": 44.4856, "maximum": 1015.296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 225.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 249.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 249.86 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 62.25, "10th_percentile": 62.25, "90th_percentile": 102.09, "count": "1 through 10" }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 310.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20093, "minimum": 18084.339, "maximum": 35163.9925, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26331.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21028.64 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 35163.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20696.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18084.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21299.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31145.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 21098.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31145.24, "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": 21098.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 33154.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21825.4 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY DUCT STONE REMOVAL S&I - 47544 - 401091649", "code_information": [ { "code": "47544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888.75, "minimum": 39.3876, "maximum": 5475.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "AQUATIC THERAPY/EXERCISES/15 M", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125, "discounted_cash": 35, "minimum": 6.3, "maximum": 125, "payers_information": [ { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 46.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 37.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.78, "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": 37.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 59.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 71.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 113.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 125 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 35.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.39, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "B-TYPE NATRIURETIC PEPTIDE", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 276.4, "discounted_cash": 39, "minimum": 32.98, "maximum": 221.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 78.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 112.28 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 124.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 124.85 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 161.4, "10th_percentile": 161.4, "90th_percentile": 161.4, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.95 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.67 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 51.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 34.96 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 41.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.47 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.97 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.85, "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": 41.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.95 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 64.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.52 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.96 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.56 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% 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": 20093, "minimum": 12942.8, "maximum": 35163.9925, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26331.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19224.95 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 35163.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20696.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18084.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21299.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31145.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 21098.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31145.24, "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": 21098.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26121.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 33154.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16689.3 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20093.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT OTHER PROCEDURE", "code_information": [ { "code": "47999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3524.45, "discounted_cash": 906, "minimum": 177.6323, "maximum": 5475.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1871 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1013.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARSENIC ASSAY", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172, "discounted_cash": 18, "minimum": 15.93, "maximum": 137.6, "payers_information": [ { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.74 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.34 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.79 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 16.89 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.28 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.74 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.34 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.68 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.31 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.67 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.25 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 60.32 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.74 }, { "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" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15893, "minimum": 14192.05, "maximum": 27813.905, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20420.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15893.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17363.05 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20661.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 27813.91, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15893.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15893.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 15893.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15893.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16370.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 15893.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15893.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20661.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 20661.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14304.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16847.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 20661.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24635.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 16688.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24635.24, "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": 16688.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 15893.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20661.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15893.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15893.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 26224.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15893.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15893.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19095.4 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15893.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15893.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 15893.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15893.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIUM,NOT SPECIFIED", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.34, "discounted_cash": 12, "minimum": 10.82, "maximum": 246.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.14 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.28 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "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": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.84 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.62 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.51 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN DIRECT - 82248 - 405082248", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.5, "discounted_cash": 5, "minimum": 4.22, "maximum": 95.352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASPARTATE AMINO TRANSFRASE (AST)", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.71, "discounted_cash": 5, "minimum": 4.35, "maximum": 200.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% 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": 28494, "minimum": 19001.9, "maximum": 49865.4275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38154.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28494.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32208.88 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 37042.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 49865.43, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28494.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28494.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 28494.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28494.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29349.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 28494.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28494.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 37042.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 37042.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 25645.08, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30204.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 37042.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 44166.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 29919.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44166.48, "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": 29919.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 28494.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 37042.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 28494.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28494.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 47015.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28494.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28494.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28236.5 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 28494.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28494.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 28494.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28494.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Balloon Dilate Ureter Strict", "code_information": [ { "code": "50706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3596.25, "minimum": 181.251, "maximum": 2877, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "BILIRUBIN, DIRECT", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.19, "discounted_cash": 5, "minimum": 4.22, "maximum": 95.352, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Aspir and/or Injec Inter Joint", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1857.98, "discounted_cash": 306, "minimum": 33.5142, "maximum": 1486.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 33.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 37.15 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 37.15 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BARBITURATES,NES", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.5, "minimum": 1, "maximum": 83.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.68 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.68 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.68 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.13 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.74 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.71 }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.02 }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.64 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.15 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.21 } ] } ] }, { "description": "BILIRUBIN, TRANSCUTANEOUS", "code_information": [ { "code": "88720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.84, "discounted_cash": 5, "minimum": 4.22, "maximum": 270.272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASPIRATION/INJ THYROID CYST", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2870.35, "discounted_cash": 707, "minimum": 101.4972, "maximum": 2296.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 101.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 112.51 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 112.51 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 991, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 750.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1167.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BASELINE PFT", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 977.82, "discounted_cash": 215, "minimum": 49.2821, "maximum": 782.256, "payers_information": [ { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 228.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 280.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 334.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 226.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 226.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 356.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 431.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 395.68 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 439.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 439.95 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 222.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 215.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 302.18, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA,AMPLIF NA PROBE", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205, "discounted_cash": 35, "minimum": 29.48, "maximum": 164, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 100.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 111.59 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.31 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "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": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.84 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.78 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.64 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.6 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN,FECES,QUAL", "code_information": [ { "code": "82252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.75, "discounted_cash": 4, "minimum": 3.83, "maximum": 74.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 9.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.04 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.06 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "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": 4.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BASIC METABOLIC PANEL - 80048 - 405010835", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.64, "discounted_cash": 8, "minimum": 7.11, "maximum": 202.912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 148.11, "10th_percentile": 148.11, "90th_percentile": 148.11, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.54 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.87 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY OF CERVIX", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4670.38, "discounted_cash": 920, "minimum": 126.6264, "maximum": 3736.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1196.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1841.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 126.63 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 140.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 140.37 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1381.07, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1196.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 975.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1196.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1427.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BASIC METABOLIC PANEL - 80048 - 405010844", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.85, "discounted_cash": 8, "minimum": 7.11, "maximum": 202.912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 148.11, "10th_percentile": 148.11, "90th_percentile": 148.11, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.54 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.87 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.13 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BCR-ABL1,CML/ALL,PCR QUANT", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 819.8, "discounted_cash": 163, "minimum": 137.73, "maximum": 655.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 327.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 468.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 521.39 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 521.39 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.82 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 245.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 137.73 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.59 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.56 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 213.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 146.61, "10th_percentile": 146.61, "90th_percentile": 146.61, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 213.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 145.99 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.37 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.14, "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": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.82 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 137.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.59 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 270.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 137.73 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.98 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.79 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHRC ABDOMINAL AORTA - 0236T - 91613", "code_information": [ { "code": "0236T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35791.4, "discounted_cash": 11539, "minimum": 1330, "maximum": 28633.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23079.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11886.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17309.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16155.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12232.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "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": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19040.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIOR CHNG SMOKING 3-10MIN - 99406 - 408090023", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.15, "discounted_cash": 37, "minimum": 6.358, "maximum": 152.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 126.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.05, "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": 39.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 61.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD CULTURE ROUTINE LABCORP", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.75, "discounted_cash": 10, "minimum": 8.67, "maximum": 325.512, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.82 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.21 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.74 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.66 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "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": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.67 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.7 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.13 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHRC BRACHIOCEPHALIC TRUNK - 0237T - 91614", "code_information": [ { "code": "0237T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35791.4, "discounted_cash": 11539, "minimum": 1330, "maximum": 28633.12, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19040.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7342 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23079.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12781.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14169.13 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11886.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17309.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16155.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12232.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17886.95, "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": 12116.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15001.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11539.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD GASES 02 SATURATIONS ONL", "code_information": [ { "code": "82810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.8, "discounted_cash": 9, "minimum": 8.21, "maximum": 116.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 31.07 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.67 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "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": 10.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.17 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.32 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AtiVAN", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00641604425", "type": "NDC" }, { "code": "J2060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 2.95, "10th_percentile": 2.95, "90th_percentile": 2.95, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 4.67, "10th_percentile": 4.67, "90th_percentile": 4.67, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 2.03, "10th_percentile": 2.03, "90th_percentile": 2.74, "count": "1 through 10" } ] } ] }, { "description": "Bile Duct Stent via Exist Acc", "code_information": [ { "code": "47538", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20591.2, "discounted_cash": 6043, "minimum": 1037.7965, "maximum": 16472.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7856.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 12086.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6235.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6912.21 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6912.21 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6224.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9064.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8460.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7856.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6405.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7856.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9367.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 6345.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9367.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6345.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7856.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 9971.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9872, "minimum": 6859, "maximum": 17550, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11946.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10944.74 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12834.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 17277.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10169.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12834.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 12834.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8885.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10465.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 12834.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15302.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 10366.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15302.95, "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": 10366.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12834.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16290.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12009.1 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD GASES O2 SATURATIONS ONLY", "code_information": [ { "code": "82810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146, "discounted_cash": 9, "minimum": 8.21, "maximum": 116.8, "payers_information": [ { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.67 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "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": 10.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.17 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.32 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.07 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 31.07 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY DUCT STONE EXTRACTION - 47544 - 91648", "code_information": [ { "code": "47544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843.9, "minimum": 39.3876, "maximum": 5475.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 } ] } ] }, { "description": "BETA 2 GLYCOPROTEIN I AB,GM", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.25, "discounted_cash": 25, "minimum": 21.38, "maximum": 101.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 50.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 72.79 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.26 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.26 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 33.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 22.66 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.74 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.01 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "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": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.26 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 41.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.18 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.7 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE BIOPSY DEEP", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4126.5, "discounted_cash": 1650, "minimum": 207.9756, "maximum": 5118.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1770.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY LYMPH NODE", "code_information": [ { "code": "38505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7148.15, "discounted_cash": 1650, "minimum": 360.2668, "maximum": 5718.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1770.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% 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": 20679, "minimum": 9900, "maximum": 36189.7025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27155.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20679.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25104.37 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26883.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 36189.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20679.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20679.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 20679.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20679.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21300.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 20679.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20679.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26883.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 26883.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18611.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21920.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9900, "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": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 26883.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32053.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 21713.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32053.69, "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": 21713.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 20679.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26883.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 20679.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20679.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 34121.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20679.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20679.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20361.8 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 20679.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20679.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 20679.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20679.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7405, "minimum": 4765.92, "maximum": 12960.1325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8474.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7248.28 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9627.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 12960.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7627.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9627.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 9627.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6665.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7850.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 9627.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11478.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 7776.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11478.97, "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": 7776.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9627.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 12219.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4765.92 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7405.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy vrt bdy open thoracic", "code_information": [ { "code": "20250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23488.6, "discounted_cash": 3270, "minimum": 1183.8254, "maximum": 18790.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3914.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3914.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3467.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% 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": 12901, "minimum": 11611.26, "maximum": 22577.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16208.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13805.06 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16771.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 22577.45, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13288.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16771.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 16771.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11611.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13675.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 16771.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19997.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 13546.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19997.17, "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": 13546.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16771.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21287.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17762.1 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12901.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW BIOPSY - 38221 - 4070038089", "code_information": [ { "code": "38221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4126.5, "discounted_cash": 1650, "minimum": 144.3252, "maximum": 3301.98, "payers_information": [ { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 144.33 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 159.99 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 159.99 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% 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" } ] } ] }, { "description": "Av fuse uppr arm cephalic", "code_information": [ { "code": "36818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13220.3, "discounted_cash": 5562, "minimum": 666.3031, "maximum": 11124.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5929.09 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6572.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5896.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6998 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/removal lymph nodes - 38500 - OR36038500", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10851.6, "discounted_cash": 3914, "minimum": 546.9206, "maximum": 8681.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 7828, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3908.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4332.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4332.26 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4031.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5871, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4148.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6458.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4100 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN DIRECT - 82248 - 405010290", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116, "discounted_cash": 5, "minimum": 4.22, "maximum": 95.352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Av fusion direct any site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15171.7, "discounted_cash": 3156, "minimum": 764.6537, "maximum": 12137.36, "payers_information": [ { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3345.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 2811.52, "10th_percentile": 2811.52, "90th_percentile": 2811.52, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4922 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1330 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3574.95 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3962.93 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN DIRECT STICK", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116, "discounted_cash": 5, "minimum": 4.22, "maximum": 95.352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRAF MUTATION ANALYSIS", "code_information": [ { "code": "81210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 389.8, "discounted_cash": 175, "minimum": 97.45, "maximum": 389.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 350.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 389.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 389.8 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 389.8 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.37 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 263.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.37 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.1 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.53 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 228.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 185.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 228.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 156.18 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 184.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 301.43 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.05 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.87, "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": 184.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.37 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 228.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.1 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 289.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.79 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 308.07 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.9 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AVULSION OF NAIL PLATE", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.65, "discounted_cash": 200, "minimum": 44.4856, "maximum": 1015.296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 225.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 249.86 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 249.86 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 72.96, "10th_percentile": 72.96, "90th_percentile": 72.96, "count": "1 through 10" }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 260.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 310.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 73.65, "10th_percentile": 73.65, "90th_percentile": 73.65, "count": "1 through 10" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN TOTAL - 82247 - 308090076", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.19, "discounted_cash": 5, "minimum": 4.22, "maximum": 95.352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AVULSION OF NAIL PLATE EA ADDL", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.25, "minimum": 12.7134, "maximum": 252.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 252.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 252.25 } ] } ] }, { "description": "BLADDER CANCER FISH AUTOMATED", "code_information": [ { "code": "88121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 995.9, "discounted_cash": 170, "minimum": 50.1934, "maximum": 901.2438, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 362.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 340.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 810.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 901.24 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 255.45, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 221.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 263.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN TOTAL - 82247 - 405010270", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.5, "discounted_cash": 5, "minimum": 4.22, "maximum": 95.352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "B2 MICROGLOBUIN,SERUM", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.9, "discounted_cash": 16, "minimum": 13.59, "maximum": 64.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.45 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.23 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 13.59 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.23 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.59 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 21.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.24 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "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": 16.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.23 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 13.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.59 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 13.59 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.42 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.02 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLASTOMYCES", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.08, "discounted_cash": 12, "minimum": 10.84, "maximum": 92.064, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.89 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.02 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.02 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.18 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "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": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.84 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.88 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.67 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.55 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN,TOTAL", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.19, "discounted_cash": 5, "minimum": 4.22, "maximum": 95.352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% 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": 12220, "minimum": 9000, "maximum": 27266.9, "payers_information": [ { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12221, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12220.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 12220.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12221, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12587.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 12220.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12220.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15887.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 15887.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10998.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12954.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 15887.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18942.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 12832.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18942.55, "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": 12832.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 12220.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15887.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12221, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12221, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20164.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12221, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12220.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14960.1 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 12220.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12221, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 12221, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12220.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15251.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12221, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12625.83 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15887.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 21386.72, "additional_payer_notes": "175.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD COLLECTION-IMP-VENOUS DEVIC", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.1, "discounted_cash": 133, "minimum": 25.205, "maximum": 500.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 266, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 311.83 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 346.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 346.72 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare 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", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.5, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 140.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 172.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133, "additional_payer_notes": "100.00% 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": 14868, "minimum": 13381.803, "maximum": 26020.1725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18977.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16440.48 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19329.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 26020.17, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14868.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 14868.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15314.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 14868.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14868.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19329.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 19329.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13381.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15760.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 19329.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23046.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 15612.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23046.49, "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": 15612.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 14868.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19329.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24533.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14868.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14350.9 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 14868.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 14868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14868.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD PATCH INJ EPIDUR CLOT/PATC", "code_information": [ { "code": "62273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1796.43, "discounted_cash": 705, "minimum": 90.5401, "maximum": 2594.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 917.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1411.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 806.31 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 893.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 893.82 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 726.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1058.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 987.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 917.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 747.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 917.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1093.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 740.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1093.71, "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": 740.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 917.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1796.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 705.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY BONE OPEN SUPERFICIAL", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12107.8, "discounted_cash": 2903, "minimum": 1161, "maximum": 9686.24, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4100 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2991.37 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3316.01 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3316.01 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3077.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL ANTIGEN SCREEN", "code_information": [ { "code": "87147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.19, "discounted_cash": 5, "minimum": 4.35, "maximum": 93.752, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD UREA NITROGEN (BUN)", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.23, "discounted_cash": 3, "minimum": 3.32, "maximum": 156.184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.56 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.74 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.52 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.14 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "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": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.74 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/removal lymph nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12431.4, "discounted_cash": 3914, "minimum": 626.5426, "maximum": 9945.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 7828, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3908.12 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4332.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4332.26 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4031.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5871, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4148.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6458.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4100 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA,NA QUAN", "code_information": [ { "code": "87472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.25, "discounted_cash": 42, "minimum": 35.99, "maximum": 217.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 122.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 136.23 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 35.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 38.15 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.44 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "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": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 35.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.06 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 35.99 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.32 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE BIOPSY SUPERFICIAL", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9628.5, "discounted_cash": 1650, "minimum": 346.626, "maximum": 7702.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1770.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BK virus quantitation Real tim", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465, "discounted_cash": 42, "minimum": 35.99, "maximum": 372, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 122.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 136.23 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 35.99 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 38.15 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.44 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "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": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 35.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.06 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 35.99 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.32 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.25 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE DEBRIDEMENT - 11044 - 309011044", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4126.5, "discounted_cash": 1650, "minimum": 207.9756, "maximum": 5718.52, "payers_information": [ { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1770.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD GASES INCLD O2 SATURATIONS", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350, "discounted_cash": 26, "minimum": 21.9, "maximum": 287.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 74.56 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 82.9 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 258.71, "10th_percentile": 258.71, "90th_percentile": 258.71, "count": "1 through 10" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 23.21 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.12 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.79 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.54 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6244, "minimum": 4051.29, "maximum": 10927.7525, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6840.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6129.02 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8117.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 10927.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6431.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8117.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 8117.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5619.99, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6619.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 8117.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9678.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 6556.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9678.87, "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": 6556.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8117.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 10303.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4051.29 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6244.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BCID PANEL", "code_information": [ { "code": "87150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 902.5, "discounted_cash": 35, "minimum": 29.48, "maximum": 722, "payers_information": [ { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 100.36 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.59 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 111.59 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.31 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "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": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.84 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.78 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.64 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.6 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW BIOPSY - 20220 - 92031", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6877.5, "discounted_cash": 1650, "minimum": 346.626, "maximum": 7702.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 868 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1770.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD SMEAR W/O DIFF WBC COUNT", "code_information": [ { "code": "85008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.6, "discounted_cash": 3, "minimum": 1, "maximum": 2.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "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": 2.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHOSCOPE DX BRUSH", "code_information": [ { "code": "31623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7483.15, "discounted_cash": 1779, "minimum": 377.1508, "maximum": 5986.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2313.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3558.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1845.49 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2045.77 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2045.77 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1832.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2668.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2490.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2313.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1885.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2313.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2757.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 1868.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2757.82, "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": 1868.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2313.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2935.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIOR CHNG SMOKING 3-10MIN - 99406 - 30090020", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.8, "discounted_cash": 37, "minimum": 6.358, "maximum": 152.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 152.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.05, "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": 39.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 61.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW BIOPSY - 38211 - 401092031", "code_information": [ { "code": "38211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1453.44, "discounted_cash": 441, "minimum": 73.2534, "maximum": 1453.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1453.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 573.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 882.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 500.57 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 554.9 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 554.9 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 454.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 573.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 467.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 573.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 683.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 463.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 683.57, "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": 463.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 727.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 814 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 441.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD SMEAR,PERIPH W/INTER - 85060 - 405085000", "code_information": [ { "code": "85060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113, "minimum": 5.6952, "maximum": 92.888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 72.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.23 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.23 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.25 } ] } ] }, { "description": "BRONCHOSCOPY NEEDLE BX ADDL", "code_information": [ { "code": "31633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 460.1, "minimum": 23.189, "maximum": 460.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 460.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 460.1 } ] } ] }, { "description": "BEHAVIOR CHNG SMOKING 3-10MIN - 99406 - 317090020", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.14, "discounted_cash": 37, "minimum": 6.358, "maximum": 152.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.05, "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": 39.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 61.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BORDATELLA P AG BY DFA", "code_information": [ { "code": "87265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.81, "discounted_cash": 11, "minimum": 10.06, "maximum": 98.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.26 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.1 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "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 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", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.42 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.81 }, { "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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.58 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.65 }, { "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": "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": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "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 Plan MMP Dual Eligible", "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 Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.42 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.03 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE DEBRIDEMENT - 11044 - 302011044", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4126.5, "discounted_cash": 1650, "minimum": 207.9756, "maximum": 5718.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1161 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1770.65 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1962.82 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1750.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRUSH BIOPSY AMPULLA - 47999 - 401091460", "code_information": [ { "code": "47999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5294.38, "discounted_cash": 906, "minimum": 177.6323, "maximum": 5475.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1871 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1013.84 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1123.87 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "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", "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 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", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% 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": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "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 Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 961.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare 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": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "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 HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan 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": "Texas Bluebonnett Health Plan 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": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2997 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BORDETELLA ANTIBODY", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120, "discounted_cash": 13, "minimum": 11.08, "maximum": 96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.72 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.94 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.94 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.08 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.72 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.67 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.84 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "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": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.08 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.03 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10787, "minimum": 7885.95, "maximum": 18878.2825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13233.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10787.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11920.23 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14023.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 18878.28, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10787.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10787.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 10787.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10787.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11111.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 10787.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10787.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14023.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 14023.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9708.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11434.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 14023.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16720.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 11326.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16720.78, "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": 11326.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 10787.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14023.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10787.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10787.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17799.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10787.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10787.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12422.1 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 10787.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10787.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 10787.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10787.59, "additional_payer_notes": "100.00% 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": 15377, "minimum": 9900, "maximum": 26911.325, "payers_information": [ { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19991.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 25373.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25918.7 }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19694.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14852.88 }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19991.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "case rate", "standard_charge_dollar": 26911.33, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15839.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15377.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19991.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "case rate", "standard_charge_dollar": 19991.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13840.11, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16300.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "case rate", "standard_charge_dollar": 19991.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23835.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "case rate", "standard_charge_dollar": 16146.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23835.75, "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": 16146.8, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BORRELIA ANTIBODY", "code_information": [ { "code": "86619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.5, "discounted_cash": 13, "minimum": 11.24, "maximum": 97.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 26.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.27 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.69 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.55 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.55 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.69 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.69 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.82 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.19 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.74, "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": 14.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.69 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.82 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.65 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "C-PEPTIDE", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.05, "discounted_cash": 20, "minimum": 17.48, "maximum": 83.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.52 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.18 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 66.18 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.48 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.48 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.69 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.76 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.61 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 17.48 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.48 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 17.48 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.67 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.55 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.75 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BENAdryl INJ", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00641037625", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 62, "median_amount": 3.6, "10th_percentile": 3.6, "90th_percentile": 3.6, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "median_amount": 20.28, "10th_percentile": 5.43, "90th_percentile": 20.28, "count": "1 through 10" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 2.79, "10th_percentile": 2.79, "90th_percentile": 3.28, "count": "18" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 3.28, "10th_percentile": 3.28, "90th_percentile": 3.28, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 2.97, "10th_percentile": 2.97, "90th_percentile": 3.49, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 3.67, "10th_percentile": 3.67, "90th_percentile": 4.33, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 1.37, "10th_percentile": 1.37, "90th_percentile": 1.37, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 1.41, "10th_percentile": 1.31, "90th_percentile": 1.49, "count": "18" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 1.91, "10th_percentile": 1.48, "90th_percentile": 2.17, "count": "12" }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.04, "median_amount": 3.55, "10th_percentile": 3.55, "90th_percentile": 4.18, "count": "1 through 10" } ] } ] }, { "description": "C1 Esterase Inhibitor function", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.36, "discounted_cash": 12, "minimum": 10.08, "maximum": 79.488, "payers_information": [ { "payer_name": "Provider Partners Health plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Rio Grande Valley Idigent Health Medicaid", "plan_name": "Rio Grande Valley Idigent Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "San Benito Medical Associates", "plan_name": "San Benito Medical Associates Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Commercial Exchange", "plan_name": "Superior Health Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Medicare Advantage HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan MMP Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas BlueBonnett Health Plan", "plan_name": "Texas Bluebonnett Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "TRIWEST BCBS", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Medicaid", "plan_name": "United CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "United Medicaid", "plan_name": "United Healthcare STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.08 }, { "payer_name": "United Medicaid", "plan_name": "United Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.04 }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "VETERANS EVALUATION SERVICES", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "WellMed", "plan_name": "WellMed Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Asserta Health", "plan_name": "Asserta Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Baker Benefits Administrators", "plan_name": "Baker Benefits Administrators", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.32 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "payer_name": "Careworks Worker Compensation FKA ROCKPORT COMMUNITY NETWORK", "plan_name": "Careworks Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Care (Humana)", "plan_name": "Choice Care Humana", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring MMP", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies Worker Compensation", "plan_name": "Corporate Remedies Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Company", "plan_name": "Imperial Insurance Companies Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative (MVEC)", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/01/2024", "methodology": "fee schedule", "standard_charge_dollar": 10.68 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.69 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZAPINES", "code_information": [ { "code": "80347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199, "minimum": 1, "maximum": 159.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS Of TX", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.35 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll CHIP Medicaid - 09-01-2024", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.35 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.18 }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid - 09/